Novel sez6 modulators and methods of use

ABSTRACT

Novel modulators, including antibodies and derivatives thereof, and methods of using such modulators to treat proliferative disorders are provided.

CROSS REFERENCED APPLICATIONS

This application claims priority from U.S. Provisional PatentApplication Ser. No. 61/871,289 filed on Aug. 28, 2013, which isincorporated herein by reference in its entirety.

SEQUENCE LISTING

The instant application contains a sequence listing which has beensubmitted in ASCII format via EFS-Web and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Aug. 27, 2014, isnamed “S69697 1130WO SEQL 082714 for filing” and is 462,073 bytes insize.

FIELD OF THE INVENTION

This application generally relates to novel compounds, compositions andmethods of their use in diagnosing, preventing, treating or amelioratingproliferative disorders and any expansion, recurrence, relapse ormetastasis thereof. In a broad aspect, the present invention relates tothe use of seizure related 6 homolog (SEZ6) modulators, includinganti-SEZ6 antibodies and fusion constructs, for the treatment, diagnosisor prophylaxis of neoplastic disorders. Selected embodiments of thepresent invention provide for the use of such SEZ6 modulators, includingantibody drug conjugates, for the immunotherapeutic treatment ofmalignancies preferably comprising a reduction in tumor initiating cellfrequency. Particularly preferred embodiments of the invention comprisemodulators that associate with specific epitopes and use of thedisclosed modulators to treat certain patient populations such as thosesuffering from medullary thyroid cancer, small cell lung cancer andpatients that are resistant to standard of care platinum based agents.

BACKGROUND OF THE INVENTION

Stem and progenitor cell differentiation and cell proliferation arenormal ongoing processes that act in concert to support tissue growthduring organogenesis and cell replacement and repair of most tissuesduring the lifetime of all living organisms. In the normal course ofevents cellular differentiation and proliferation is controlled bynumerous factors and signals that are generally balanced to maintaincell fate decisions and tissue architecture. Thus, to a large extent itis this controlled microenvironment that regulates cell division andtissue maturation where signals are properly generated based on theneeds of the organism. In this regard cell proliferation anddifferentiation normally occur only as necessary for the replacement ofdamaged or dying cells or for growth. Unfortunately, disruption of cellproliferation and/or differentiation can result from a myriad of factorsincluding, for example, the under- or overabundance of various signalingchemicals, the presence of altered microenvironments, genetic mutationsor some combination thereof. When normal cellular proliferation and/ordifferentiation is disturbed or somehow disrupted it can lead to variousdiseases or disorders including proliferative disorders such as cancer.

Conventional treatments for cancer include chemotherapy, radiotherapy,surgery, immunotherapy (e.g., biological response modifiers, vaccines ortargeted therapeutics) or combinations thereof. Unfortunately, certaincancers are non-responsive or minimally responsive to such treatments.For example, in some patients tumors exhibit gene mutations that renderthem non-responsive despite the general effectiveness of selectedtherapies. Moreover, depending on the type of cancer and what form ittakes some available treatments, such as surgery, may not be viablealternatives. Limitations inherent in current standard of caretherapeutics are particularly evident when attempting to treat patientswho have undergone previous treatments and have subsequently relapsed.In such cases the failed therapeutic regimens and resulting patientdeterioration may contribute to refractory tumors which often manifestthemselves as a relatively aggressive disease that ultimately proves tobe incurable. Although there have been great improvements in thediagnosis and treatment of cancer over the years, overall survival ratesfor many solid tumors have remained largely unchanged due to the failureof existing therapies to prevent relapse, tumor recurrence andmetastases. Thus, it remains a challenge to develop more targeted andpotent therapies for proliferative disorders.

SUMMARY OF THE INVENTION

These and other objectives are provided for by the present inventionwhich, in a broad sense, is directed to methods, compounds, compositionsand articles of manufacture that may be used in the treatment of SEZ6associated disorders (e.g., proliferative disorders or neoplasticdisorders). To that end, the present invention provides novel seizurerelated 6 homolog (or SEZ6) modulators that effectively target tumorcells and/or cancer stem cells and may be used to treat patientssuffering from a wide variety of malignancies. As will be discussed inmore detail herein, there are at least two naturally occurring SEZ6isoforms or variants and the disclosed modulators may comprise orassociate selectively with one isoform or the other or with both.Moreover, in certain embodiments the disclosed SEZ6 modulators mayfurther react with one or more SEZ family members (e.g., SEZ6L orSEZ6L2) or, in other embodiments, may be generated and selected for soas to exclusively associate or react with SEZ6 isoform(s). In preferredembodiments the invention is more particularly directed to isolated SEZ6modulators comprising antibodies (i.e., antibodies thatimmunopreferentially bind, react with or associate with at least oneisoform of SEZ6) that, in particularly preferred embodiments, areassociated or conjugated to one or more cytotoxic agents or therapeuticmoieties, for example, auristatins, amanitins andpyrrolobenzodiazepines. Moreover, as discussed extensively below, suchmodulators may be used to provide pharmaceutical compositions useful forthe prophylaxis, diagnosis or treatment of proliferative disorders.

In selected embodiments of the invention, SEZ6 modulators may comprise aSEZ6 polypeptide or fragments thereof, either in an isolated form orfused or associated with other moieties (e.g., Fc-SEZ6, PEG-SEZ6 or SEZ6associated with a targeting moiety). In other selected embodiments SEZ6modulators may comprise SEZ6 antagonists which, for the purposes of theinstant application, shall be held to mean any construct or compoundthat recognizes, competes, interacts, binds or associates with SEZ6 andneutralizes, eliminates, reduces, sensitizes, reprograms, inhibits orcontrols the growth of neoplastic cells including tumor initiatingcells. In preferred embodiments the SEZ6 modulators of the instantinvention comprise anti-SEZ6 antibodies, or fragments or derivativesthereof, that have unexpectedly been found to silence, neutralize,reduce, decrease, deplete, moderate, diminish, reprogram, eliminate, orotherwise inhibit the ability of tumor initiating cells to propagate,maintain, expand, proliferate or otherwise facilitate the survival,recurrence, regeneration and/or metastasis of neoplastic cells. Inparticularly preferred embodiments the antibodies or immunoreactivefragments may be associated with or conjugated to one or moreanti-cancer agents (e.g., a cytotoxic agent).

With regard to such modulators it will be appreciated that compatibleantibodies may take on any one of a number of forms including, forexample, polyclonal and monoclonal antibodies, chimeric, CDR grafted,humanized and human antibodies and immunoreactive fragments and/orvariants of each of the foregoing. Preferred embodiments will compriseantibodies that are relatively non-immunogenic such as humanized orfully human constructs. Of course, in view of the instant disclosurethose skilled in the art could readily identify one or morecomplementarity determining regions (CDRs) associated with heavy andlight chain variable regions of SEZ6 antibody modulators and use thoseCDRs to engineer or fabricate chimeric, humanized or CDR graftedantibodies without undue experimentation. Accordingly, in certainpreferred embodiments the SEZ6 modulator comprises an antibody thatincorporates one or more CDRs derived from the light (FIG. 10A) or heavy(FIG. 10B) contiguous chain murine variable regions (SEQ ID NOS: 20-169)set forth therein. Such CDR grafted variable regions having a humanframework and variants thereof are also shown in FIG. 10 comprising SEQID NOS: 170-199. In preferred embodiments such antibodies will comprisemonoclonal antibodies and, in even more preferred embodiments, willcomprise chimeric, CDR grafted or humanized antibodies.

Exemplary nucleic acid sequences encoding each of the amino acidsequences set forth in FIGS. 10A and 10B are set forth in the appendedsequence listing and comprise SEQ ID NOS: 220 to 399. In this respect itwill be appreciated that the invention further comprises nucleic acidmolecules (and associated constructs, vectors and host cells) encodingdisclosed antibody variable region amino acid sequences including thoseset forth in the sequence listing.

More particularly, in selected embodiments compatible SEZ6 modulatorsmay comprise an antibody having a light chain variable region and aheavy chain variable region wherein said light chain variable regioncomprises an amino acid sequence having at least 60% identity to anamino acid sequence selected from the group consisting of amino acidsequences as set forth in SEQ ID NO: 20, SEQ ID NO: 22, SEQ ID NO: 24,SEQ ID NO: 26,

SEQ ID NO: 28, SEQ ID NO: 30, SEQ ID NO: 32, SEQ ID NO: 34, SEQ ID NO:36, SEQ ID NO: 38, SEQ ID NO: 40, SEQ ID NO: 42, SEQ ID NO: 44, SEQ IDNO: 46, SEQ ID NO: 48, SEQ ID NO: 50, SEQ ID NO: 52, SEQ ID NO: 54, SEQID NO: 56, SEQ ID NO: 58, SEQ ID NO: 60, SEQ ID NO: 62, SEQ ID NO: 64,SEQ ID NO: 66, SEQ ID NO: 68, SEQ ID NO: 70, SEQ ID NO: 72, SEQ ID NO:74, SEQ ID NO: 76, SEQ ID NO: 78 SEQ ID NO: 80, SEQ ID NO: 82, SEQ IDNO: 84, SEQ ID NO: 86, SEQ ID NO: 88, SEQ ID NO: 90, SEQ ID

NO: 92, SEQ ID NO: 94, SEQ ID NO: 96, SEQ ID NO: 98, SEQ ID NO: 100, SEQID NO: 102, SEQ ID NO: 104, SEQ ID NO: 106, SEQ ID NO: 108, SEQ ID NO:110, SEQ ID NO: 112, SEQ ID NO: 114, SEQ ID NO: 116, SEQ ID NO: 118, SEQID NO: 120, SEQ ID NO: 122, SEQ ID NO: 124, SEQ ID NO: 126, SEQ ID NO:128, SEQ ID NO: 130, SEQ ID NO: 132, SEQ ID NO: 134, SEQ ID NO: 136, SEQID NO: 138, SEQ ID NO: 140, SEQ ID NO: 142, SEQ ID NO: 144, SEQ ID NO:146, SEQ ID NO: 148, SEQ ID NO: 150, SEQ ID NO: 152, SEQ ID NO: 154, SEQID NO: 156, SEQ ID NO: 158, SEQ ID NO: 160, SEQ ID NO: 162, SEQ ID NO:164, SEQ ID NO: 166 and SEQ ID NO: 168 and wherein said heavy chainvariable region comprises an amino acid sequence having at least 60%identity to an amino acid sequence selected from the group consisting ofamino acid sequences as set forth in SEQ ID NO: 21, SEQ ID NO: 23, SEQID NO: 25, SEQ ID NO: 27, SEQ ID NO: 29, SEQ ID NO: 31, SEQ ID NO: 33,SEQ ID NO: 35, SEQ ID NO: 37, SEQ ID NO: 39, SEQ ID NO: 41, SEQ ID NO:43, SEQ ID NO: 45, SEQ ID NO: 47, SEQ ID NO: 49, SEQ ID NO: 51 , SEQ IDNO: 53, SEQ ID NO: 55, SEQ ID NO: 57, SEQ ID NO: 59, SEQ ID NO: 61, SEQID NO: 63, SEQ ID NO: 65, SEQ ID NO: 67, SEQ ID NO: 69, SEQ ID NO: 71,SEQ ID NO: 73, SEQ ID NO: 75, SEQ ID NO: 77, SEQ ID NO: 79, SEQ ID NO:81, SEQ ID NO: 83, SEQ ID NO: 85, SEQ ID NO: 87, SEQ ID NO: 89, SEQ IDNO: 91, SEQ ID NO: 93, SEQ ID NO: 95, SEQ ID NO: 97, SEQ ID NO: 99, SEQID NO: 101, SEQ ID NO: 103, SEQ ID NO: 105, SEQ ID NO: 107, SEQ ID NO:109, SEQ ID NO: 111, SEQ ID NO: 113, SEQ ID NO: 115, SEQ ID NO: 117, SEQID NO: 119, SEQ ID NO: 121, SEQ ID NO: 123, SEQ ID NO: 125, SEQ ID NO:127, SEQ ID NO: 129, SEQ ID NO: 131, SEQ ID NO: 133, SEQ ID NO: 135, SEQID NO: 137, SEQ ID NO: 139, SEQ ID NO: 141, SEQ ID NO: 143, SEQ ID NO:145, SEQ ID NO: 147, SEQ ID NO: 149, SEQ ID NO: 151, SEQ ID NO: 153, SEQID NO: 155, SEQ ID NO: 157, SEQ ID NO: 159, SEQ ID NO: 161, SEQ ID NO:163, SEQ ID NO: 165, SEQ ID NO: 167 and SEQ ID NO: 169. In otherpreferred embodiments the selected modulators will comprise heavy andlight chain variable regions that comprise 65, 70, 75 or 80% identity tothe aforementioned murine sequences. In still other embodiments themodulators will comprise heavy and light chain variable regions thatcomprise 85, 90 or even 95% identity to the disclosed murine sequences.

Of course, in view of the instant disclosure those skilled in the artcould readily identify CDRs associated with each of the aforementionedheavy and light chain variable regions and use those CDRs to engineer orfabricate chimeric, humanized or CDR grafted antibodies without undueexperimentation. In this regard several website databases are availablethat automatically designate CDRs and framework regions (as per any ofthe commonly used numbering systems) upon entry of the subject heavy orlight chain variable region nucleic acid or amino acid sequence. Assuch, in selected embodiments the present invention is directed toanti-SEZ6 antibodies comprising one or more CDRs derived from a variableregion sequence set forth in FIG. 10A or FIG. 10B. In preferredembodiments such antibodies will comprise monoclonal antibodies and, ineven more preferred embodiments will comprise chimeric, CDR grafted orhumanized antibodies. As discussed in more detail below still otherembodiments will comprise such antibodies conjugated or associated withone or more cytotoxic agents.

Another aspect of the invention comprises modulators obtained or derivedfrom SC17.1, SC17.2, SC17.3, SC17.4, SC17.8, SC17.9, SC17.10, SC17.11,SC17.14, SC17.15, SC17.16, SC17.17, SC17.18, SC17.19, SC17.22, SC17.24,SC17.27, SC17.28, SC17.29, SC17.30, SC17.32, SC17.34, SC17.35, SC17.36,SC17.38, SC17.39, SC17.40, SC17.41, SC17.42, SC17.45, SC17.46, SC17.47,SC17.49, SC17.50, SC17.53, SC17.54, SC17.56, SC17.57, SC17.59, SC17.61,SC17.63, SC17.71, SC17.72, SC17.74, SC17.76, SC17.77, SC17.79, SC17.81,SC17.82, SC17.84, SC17.85, SC17.87, SC17.89, SC17.90, SC17.91, SC17.93,SC17.95, SC17.97, SC17.99, SC17.102, SC17.114, SC17.115, SC17.120,SC17121, SC17.122, SC17.140, SC17.151, SC17.156, SC17.161, SC17.166,SC17.187, SC17.191, SC17.193, SC17.199 and SC17.200.

In yet other compatible embodiments the instant invention will comprisethe CDR grafted or humanized SEZ6 modulators hSC17.16, hSC17.17,hSC17.24, hSC17.28, SC17.34, hSC17.46, SC17.151, SC17.155, SC17.156,SC17.161 and SC17.200. Still other embodiments are directed to a SEZ6modulator comprising a humanized antibody wherein said humanizedantibody comprises a light chain variable region and a heavy chainvariable region wherein said light chain variable region comprises anamino acid sequence having at least 60% identity to an amino acidsequence selected from the group consisting of amino acid sequences asset forth in SEQ ID NO: 170, SEQ ID NO: 172, SEQ ID NO: 174, SEQ ID NO:176, SEQ ID NO: 178, SEQ ID NO: 180, SEQ ID NO: 182, SEQ ID NO: 184, SEQID NO: 186, SEQ ID NO: 188 and SEQ ID NO: 190 and wherein said heavychain variable region comprises an amino acid sequence having at least60% identity to an amino acid sequence selected from the groupconsisting of amino acid sequences as set forth in SEQ ID NO: 171, SEQID NO: 173, SEQ ID NO: 175, SEQ ID NO: 177, SEQ ID NO: 179 and SEQ IDNO: 181, SEQ ID NO: 183, SEQ ID NO: 185, SEQ ID NO: 187, SEQ ID NO: 189and SEQ ID NO: 191. Additionally, certain humanized variants of light(SEQ ID NO: 192) and heavy (SEQ ID NO: 193, SEQ ID NO: 194, SEQ ID NO:195, SEQ ID NO: 196, SEQ ID NO: 197, SEQ ID NO: 198 and SEQ ID NO: 199)chain variable regions are provided in accordance with the teachingsherein. Moreover, as described immediately above nucleic acid sequencesencoding the exemplified humanized heavy and light chain variableregions are set forth in the appended sequence listing as SEQ ID NOS:370-399.

Besides the aforementioned aspects, other preferred embodiments of theinstant invention will comprise SEZ6 modulators associated or conjugatedto one or more drugs or therapeutic moieties (e.g. auristatins,amanitins and pyrrolobenzodiazepines) to provide modulator conjugatesthat may be particularly effective in treating proliferative disorders(alone or in combination with other pharmaceutically active agents).More generally, once the modulators of the invention have beenfabricated and selected they may be linked with, fused to, conjugated to(e.g., covalently or non-covalently) or otherwise associated withpharmaceutically active or diagnostic moieties or biocompatiblemodifiers. As used herein the term “conjugate” or “modulator conjugate”or “antibody conjugate” will be used broadly and held to mean anybiologically active or detectable molecule or drug associated with thedisclosed modulators regardless of the method of association. In thisrespect it will be understood that such conjugates may, in addition tothe disclosed modulators, comprise peptides, polypeptides, proteins,prodrugs which are metabolized to an active agent in vivo, polymers,nucleic acid molecules, small molecules, binding agents, mimetic agents,synthetic drugs, inorganic molecules, organic molecules andradioisotopes. Moreover, as indicated above the selected drug ortherapeutic moiety may be covalently or non-covalently associated with,or linked to, the modulator and exhibit various stoichiometric molarratios depending, at least in part, on the method used to effect theconjugation.

Particularly preferred aspects of the instant invention will compriseantibody modulator conjugates or antibody-drug conjugates that may beused for the diagnosis and/or treatment of proliferative disorders. Suchconjugates may be represented by the formula M-[L-D]n where M stands fora disclosed modulator or target binding moiety, L is an optional linkeror linker unit, D is a compatible drug or prodrug and n is an integerfrom about 1 to about 20. It will be appreciated that, unless otherwisedictated by context, the terms “antibody-drug conjugate” or “ADC” or theformula M-[L-D]n shall be held to encompass conjugates comprising boththerapeutic and diagnostic moieties. In such embodiments antibody-drugconjugate compounds will typically comprise anti-SEZ6 as the modulatorunit (M), a therapeutic or diagnostic moiety (D), and optionally alinker (L) that joins the drug and the antigen binding agent. Modulatorscan be directly or indirectly conjugated to a therapeutic or diagnosticmoiety. Modulators that are joined to the therapeutic or diagnosticmoiety with a linker are referred to as being “indirectly conjugated”whereas antibodies that are joined to the therapeutic or diagnosticmoiety in the absence of a linker are referred to as being “directlyconjugated”. In a preferred embodiment, the antibody is a SEZ6 mAbcomprising at least one CDR from the heavy and light chain variableregions as described above.

As previously indicated one aspect of the invention may comprise theunexpected association of SEZ6 polypeptides with cancer stem cells.Thus, in certain other embodiments the invention will comprise a SEZ6modulator that reduces the frequency of tumor initiating cells uponadministration to a subject. Preferably the reduction in frequency willbe determined using in vitro or in vivo limiting dilution analysis. Inparticularly preferred embodiments such analysis may be conducted usingin vivo limiting dilution analysis comprising transplant of live humantumor cells into immunocompromised mice. Alternatively, the limitingdilution analysis may be conducted using in vitro limiting dilutionanalysis comprising limiting dilution deposition of live human tumorcells into in vitro colony supporting conditions. In either case, theanalysis, calculation or quantification of the reduction in frequencywill preferably comprise the use of Poisson distribution statistics toprovide an accurate accounting. It will be appreciated that, while suchquantification methods are preferred, other, less labor intensivemethodology such as flow cytometry or immunohistochemistry may also beused to provide the desired values and, accordingly, are expresslycontemplated as being within the scope of the instant invention. In suchcases the reduction in frequency may be determined using flow cytometricanalysis or immunohistochemical detection of tumor cell surface markersknown to enrich for tumor initiating cells.

As such, another preferred embodiment of the instant invention comprisesa method of treating a SEZ6 associated disorder comprising administeringa therapeutically effective amount of a SEZ6 modulator to a subject inneed thereof whereby the frequency of tumor initiating cells is reduced.Preferably the SEZ6 associated disorder comprises a neoplastic disorder.Again, the reduction in the tumor initiating cell frequency willpreferably be determined using in vitro or in vivo limiting dilutionanalysis.

In this regard it will be appreciated that the present invention isbased, at least in part, upon the discovery that SEZ6 immunogens areassociated with tumor perpetuating cells (i.e., cancer stem cells) thatare involved in the etiology of various neoplasia. More specifically,the instant application unexpectedly demonstrates that theadministration of various exemplary SEZ6 modulators can mediate, reduce,deplete, inhibit or eliminate tumorigenic signaling by tumor initiatingcells (i.e., reduce the frequency of tumor initiating cells). Thisreduced signaling, whether by depletion, neutralization, reduction,elimination, reprogramming or silencing of the tumor initiating cells orby modifying tumor cell morphology (e.g., induced differentiation, nichedisruption), in turn allows for the more effective treatment of SEZ6associated disorders by inhibiting tumorigenesis, tumor maintenance,expansion and/or metastasis and recurrence.

Besides the aforementioned association with cancer stem cells, there isevidence that SEZ6 isoforms may be implicated in the growth, recurrenceor metastatic potential of tumors comprising neuroendocrine features.For the purposes of the instant invention such tumors will compriseneuroendocrine tumors (e.g. small cell lung cancer and medullary thyroidtumors) and pseudo neuroendocrine tumors. Intervention in theproliferation of such tumorigenic cells using the novel SEZ6 modulatorsdescribed herein, may thereby ameliorate or treat a disorder by morethan one mechanism (i.e., tumor initiating cell reduction and disruptionof oncogenic pathway signaling) to provide additive or synergisticeffects. Still other preferred embodiments may take advantage of thecellular internalization of cell surface SEZ6 to deliver a modulatormediated anti-cancer agent. In this regard it will be appreciated thatthe present invention is not limited by any particular mechanism ofaction but rather encompasses the broad use of the disclosed modulatorsto treat SEZ6 associated disorders (including various neoplasia).

Thus, in other embodiments the present invention will comprise the useof the disclosed modulators to treat tumors comprising neuroendocrinefeatures, e.g. small cell lung cancer and medullary thyroid tumors in asubject in need thereof. Of course the same modulators may be used forthe prophylaxis, prognosis, diagnosis, theragnosis, inhibition ormaintenance therapy of these same tumors.

It has further been discovered that the disclosed modulators areeffective in treating patients that are suffering from small cell lungcancer or medullary thyroid cancer. Moreover, as discussed in moredetail below and set forth in the Examples the anti-SEZ6 antibodies andantibody drug conjugates of the instant invention are particularlyeffective in treating certain patient populations such as thosesuffering from forms of small cell lung cancer that are resistant tostandard of care platinum based agents (e.g., carboplatin, cisplatin oroxaliplatin). Accordingly, in selected embodiments the present inventioncomprises a method of treating a patient suffering from platinumresistant small cell lung cancer comprising the step of administering aSEZ6 modulator.

Other facets of the instant invention exploit the ability of thedisclosed modulators to potentially disrupt oncogenic pathways whilesimultaneously silencing tumor initiating cells. Such multi-active SEZ6modulators (e.g., SEZ6 antagonists) may prove to be particularlyeffective when used in combination with standard of care anti-canceragents or debulking agents. Accordingly preferred embodiments of theinstant invention comprise using the disclosed modulators asanti-metastatic agents for maintenance therapy following initialtreatments. In addition, two or more SEZ6 antagonists (e.g. antibodiesthat specifically bind to two discrete epitopes on SEZ6) may be used incombination in accordance with the present teachings. Moreover, asdiscussed in some detail below, the SEZ6 modulators of the presentinvention may be used in a conjugated or unconjugated state and,optionally, as a sensitizing agent in combination with a variety ofchemical or biological anti-cancer agents.

Accordingly another preferred embodiment of the instant inventioncomprises a method of sensitizing a tumor in a subject for treatmentwith an anti-cancer agent comprising the step of administering a SEZ6modulator to said subject. Other embodiments comprise a method ofreducing metastasis or tumor recurrence following treatment comprisingadministering a SEZ6 modulator to a subject in need thereof In aparticularly preferred aspect of the invention the SEZ6 modulator willspecifically result in a reduction of tumor initiating cell frequency asdetermined using in vitro or in vivo limiting dilution analysis.

More generally preferred embodiments of the invention comprise a methodof treating a SEZ6 associated disorder in a subject in need thereofcomprising the step of administering a SEZ6 modulator to the subject. Inparticularly preferred embodiments the SEZ6 modulator will be associated(e.g., conjugated) with an anti-cancer agent. In yet other embodimentsthe SEZ6 modulator will internalize following association or bindingwith SEZ6 on or near the surface of the cell. Moreover the beneficialaspects of the instant invention, including any disruption of signalingpathways and collateral benefits, may be achieved whether the subjecttumor tissue exhibits elevated levels of SEZ6 or reduced or depressedlevels of SEZ6 as compared with normal adjacent tissue. Particularlypreferred embodiments will comprise the treatment of disordersexhibiting elevated levels of SEZ6 on tumorigenic cells as compared tonormal tissue or non-tumorigenic cells.

In yet another aspect the present invention will comprise a method oftreating a subject suffering from a neoplastic disorder comprising thestep of administering a therapeutically effective amount of at least oneinternalizing SEZ6 modulator. Preferred embodiments will comprise theadministration of internalizing antibody modulators wherein, in otherselected embodiments, the internalizing antibody modulators areconjugated or associated with a cytotoxic agent.

Other embodiments are directed to a method of treating a subjectsuffering from a SEZ6 associated disorder comprising the step ofadministering a therapeutically effective amount of at least onedepleting SEZ6 modulator.

In yet another embodiment the present invention provides methods ofmaintenance therapy wherein the disclosed effectors or modulators areadministered over a period of time following an initial procedure (e.g.,chemotherapeutic, radiation or surgery) designed to remove at least aportion of the tumor mass. Such therapeutic regimens may be administeredover a period of weeks, a period of months or even a period of yearswherein the SEZ6 modulators may act prophylactically to inhibitmetastasis and/or tumor recurrence. In yet other embodiments thedisclosed modulators may be administrated in concert with knowndebulking regimens to prevent or retard metastasis, tumor maintenance orrecurrence.

It will further be appreciated that the SEZ6 modulators of the instantinvention may be generated and selected to react with known isoform(s)of SEZ6 or a single isoform of the protein or, conversely, may comprisea pan-SEZ6 modulator that reacts or associates with at least oneadditional SEZ6 family member (e.g., SEZ6L or SEZ6L2 and isoformsthereof) in addition to SEZ6. More specifically, as disclosed hereinpreferred modulators such as antibodies may be generated and selected sothat they react with domains (or epitopes therein) that are exhibited bySEZ6 only or with domains that are at least somewhat conserved acrosstwo or more of the SEZ6 family members.

In yet other preferred embodiments the modulators will associate or bindto a specific epitope, portion, motif or domain of SEZ6. As will bediscussed in some detail below both SEZ6 isoforms incorporate anidentical extracellular region (see FIG. 1E) comprising at least anN-terminal domain, two alternating Sushi and CUB domains, and threeadditional tandem Sushi domain repeats. In addition the SEZ6 proteincomprises a transmembrane domain and a cytoplasmic domain. Accordingly,in certain embodiments the modulators will bind or associate with theN-terminal domain of SEZ6 (i.e. amino acids 1-335 in the mature protein)or to an epitope therein. Other aspects of the instant inventioncomprise modulators that associate or bind to a specific epitope locatedin a particular Sushi domain of SEZ6. In this regard the particularmodulator may associate or bind to an epitope located in Sushi Domain 1(amino acids 336-395), Sushi Domain 2 (amino acids 511-572), SushiDomain 3 (amino acids 690-748), Sushi Domain 4 (amino acids 750-813) orSushi Domain 5 (amino acids 817-878). Other aspects of the instantinvention comprise modulators that associate or bind to a specificepitope located in a particular CUB-like domain of SEZ6. In this regardthe particular modulator may associate or bind to an epitope located inCUB Domain 1 (amino acids 397-508) or CUB Domain 2 (amino acids574-685). In a further embodiment the antibodies of the invention maybind to certain epitopes on SEZ6.

In one embodiment, the invention provides for an isolated antibody thatspecifically binds to an epitope on a SEZ6 protein, wherein the epitopecomprises amino acid residues selected from the group consisting of (i)residues R762, L764, Q777, 1779, D781 and Q782; (ii) residues R342 andK389 and (iii) residues T352, S353 and H375.

In another embodiment the invention provides for an antibody drugconjugate comprising an antibody conjugated directly or indirectly to atherapeutic moiety, wherein the antibody specifically binds to anepitope on a SEZ6 protein, wherein the epitope comprises amino acidresidues selected from the group consisting of (i) residues R762, L764,Q777, I779, D781 and Q782; (ii) residues R342 and K389 and (iii)residues T352, S353 and H375.

Of course it will be appreciated that each of the aforementioned domainsmay comprise more than one epitope and may be associated with more thanone bin. With regard to modulator or antibody “bins” it will beappreciated that the SEZ6 antigen may be analyzed or mapped throughcompetitive antibody binding using art recognized techniques to definespecific bins located along the protein. While discussed in more detailherein and shown in Examples 9 and 10 below, two antibodies (one ofwhich may be termed a “reference antibody,” “bin delineating antibody”or “delineating antibody”) may be considered to be in the same bin ifthey substantially compete with each other for binding to the targetantigen. In such cases the subject antibody epitopes may be identical,substantially identical or close enough (either in a linear sense wherethey are separated by a few amino acids or conformationally) so thatboth antibodies are sterically or electrostatically inhibited orprecluded from binding to the antigen. Such defined bins may begenerally associated with certain SEZ6 domains (e.g. the referenceantibody will bind with an epitope contained in a specific domain)though the correlation is not always precise (e.g., there may be morethan one bin in a domain or the bin may be defined conformationally andcomprise more than one domain). It will be appreciated that thoseskilled in the art can readily determine the relationship between theSEZ6 domains and empirically determined bins.

With regard to the present invention competitive binding analysis usingart-recognized techniques (e.g., ELISA, surface plasmon resonance orbio-layer interferometry) defined at least seven distinct bins, each ofwhich was found to contain a number of antibody modulators. For thepurposes of the instant disclosure the seven bins were termed bins A-Fand bin U. Bins A-F are unique bins and the antibodies contained in eachof these bins compete with each other for binding to the SEZ6 protein.Bin U contains antibodies that do not compete with antibodies in BinsA-F, but may compete for binding with each other. Thus, in selectedembodiments the present invention will comprise a modulator residing ina bin selected from the group consisting of bin A, bin B, bin C, bin D,bin E, bin F, and bin U. In other embodiments the present inventioncomprises a modulator residing in a bin defined by a reference antibodyselected from the group consisting of SC17.1, SC17.2, SC17.3, SC17.4,SC17.8, SC17.9, SC17.10, SC17.11, SC17.14, SC17.15, SC17.16, SC17.17,SC17.18, SC17.19, SC17.22, SC17.24, SC17.27, SC17.28, SC17.29, SC17.30,SC17.32, SC17.34, SC17.35, SC17.36, SC17.38, SC17.39, SC17.40, SC17.41,SC17.42, SC17.45, SC17.46, SC17.47, SC17.49, SC17.50, SC17.53, SC17.54,SC17.56, SC17.57, SC17.59, SC17.61, SC17.63, SC17.71, SC17.72, SC17.74,SC17.76, SC17.77, SC17.79, SC17.81, SC17.82, SC17.84, SC17.85, SC17.87,SC17.89, SC17.90, SC17.91, SC17.93, SC17.95, SC17.97, SC17.99, SC17.102,SC17.114, SC17.115, SC17.120, SC17121, SC17.122, SC17.140, SC17.151,SC17.156, SC17.161, SC17.166, SC17.187, SC17.191, SC17.193, SC17.199 andSC17.200. In still other embodiments the invention will comprisemodulators from bin A, modulators from bin B, modulators from bin C,modulators from bin D, modulators from bin E, modulators from bin F ormodulators from bin U. Yet other preferred embodiments will comprise areference antibody modulator and any antibody that competes with thereference antibody.

The term “compete” or “competing antibody” when used in the context ofthe disclosed modulators means binding competition between antibodies asdetermined by an assay in which a reference antibody or immunologicallyfunctional fragment substantially prevents or inhibits (e.g., greaterthan 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85% or 90%.) specificbinding of a test antibody to a common antigen. Compatible methods fordetermining such competition comprise art known techniques such as, forexample, bio-layer interferometry, surface plasmon resonance, flowcytometry, competitive ELISA, etc.

In a selected embodiment the invention comprises a pan-SEZ6 modulatorthat associates with SEZ6 and at least one other SEZ6 family member(e.g., SEZ6L or SEZ6L2). In other selected embodiments the inventioncomprises a SEZ6 modulator that immunospecifically associates with oneor more isoform of SEZ6 but does not immunospecifically associate withany other SEZ6 family member. In yet other embodiments the presentinvention comprises a method of treating a subject in need thereofcomprising administering a therapeutically effective amount of apan-SEZ6 modulator. Still other embodiments comprise a method oftreating a subject in need thereof comprising administering atherapeutically effective amount of a SEZ6 modulator thatimmunospecifically associates with one or more isoforms of SEZ6 but doesnot immunospecifically associate with any other SEZ6 family member.

In one embodiment the invention is directed to a method of treating asubject suffering from cancer comprising administering a therapeuticallyeffective amount of an antibody drug conjugate comprising an antibodyconjugated directly or indirectly to a therapeutic moiety, wherein theantibody specifically binds to an epitope on a SEZ6 protein, wherein theepitope comprises amino acid residues selected from the group consistingof (i) residues R762, L764, Q777, I779, D781 and Q782; (ii) residuesR342 and K389 and (iii) residues T352, 5353 and H375. In preferredembodiments the therapeutic moiety will comprise auristatins, amanitinsand pyrrolobenzodiazepines. In some cases the subject suffering fromcancer may have previously been treated with a platinum based agent.

In another embodiment the invention is directed to a method of treatinga subject suffering from medullary thyroid cancer comprisingadministering a therapeutically effective amount of an antibody drugconjugate comprising an antibody conjugated directly or indirectly to atherapeutic moiety. In one embodiment the antibody drug conjugate usedto treat a subject suffering from medullary thyroid cancer may comprisean antibody that specifically binds to an epitope on a SEZ6 protein,wherein the epitope comprises amino acid residues selected from thegroup consisting of (i) residues R762, L764, Q777, I779, D781 and Q782;(ii) residues R342 and K389 and (iii) residues T352, S353 and H375. In apreferred embodiment the therapeutic moiety may comprise auristatins,amanitins and pyrrolobenzodiazepines.

In a further embodiment the invention is directed to a method oftreating a subject suffering from platinum resistant small cell lungcancer comprising administering a therapeutically effective amount of anantibody drug conjugate comprising an antibody conjugated directly orindirectly to a therapeutic moiety, wherein the antibody specificallybinds to an epitope on a SEZ6 protein, wherein the epitope comprisesamino acid residues selected from the group consisting of (i) residuesR762, L764, Q777, I779, D781 and Q782; (ii) residues R342 and K389 and(iii) residues T352, S353 and H375. In preferred embodiments the patientsuffering from platinum resistant small cell lung cancer have previouslybeen treated with a platinum based agent. In another preferredembodiments the therapeutic moiety will comprise auristatins, amanitinsand pyrrolobenzodiazepines.

Beyond the therapeutic uses discussed above it will also be appreciatedthat the modulators of the instant invention may be used to detect,diagnose or classify SEZ6 related disorders and, in particular,proliferative disorders. In some embodiments the modulator may beadministered to the subject and detected or monitored in vivo. Those ofskill in the art will appreciate that such modulators may be labeled orassociated with markers or reporters as disclosed below and detectedusing any one of a number of standard techniques (e.g., MRI, CAT scanPET scan, etc.).

Thus, in some embodiments the invention will comprise a method ofdiagnosing, detecting or monitoring a SEZ6 associated disorder in vivoin a subject in need thereof comprising the step of administering a SEZ6modulator.

In other instances the modulators may be used in an in vitro diagnosticsetting using art-recognized procedures. As such, a preferred embodimentcomprises a method of diagnosing cancer (e.g. medullary thyroid canceror platinum resistant small cell lung cancer) in a subject comprisingthe steps of: (a) providing a tumor sample from a subject; (b) exposingthe tumor sample to an anti-SEZ6 antibody labeled with a reporterwherein said anti-SEZ6 antibody associates with the tumor sample (e.g. amedullary thyroid tumor sample, a small cell lung cancer tumor sample ora platinum resistant small cell lung cancer tumor sample); and (c)detecting the reporter associated with the tumor sample. In someembodiments, the step of providing the tumor sample may be performedseparately from the step of exposing the tumor sample to an anti-SEZ6antibody or the step of detecting the reporter associated with the tumorsample. In some cases the reporter associated with the tumor sample willbe detected in vitro, for example, using immunohistochemistry. In somecases the tumor sample will be exposed to an anti-SEZ6 antibody thatbinds to an epitope on a SEZ6 protein, wherein the epitope comprisesamino acid residues R762, L764, Q777, I779, D781 and Q782. Such methodsmay be easily discerned in conjunction with the instant application andmay be readily performed using generally available commercial technologysuch as automatic plate readers, dedicated reporter systems, etc. Inselected embodiments the SEZ6 modulator will be associated with tumorperpetuating cells present in the sample. In other preferred embodimentsthe detecting or quantifying step will comprise a reduction of tumorinitiating cell frequency and detection thereof. Moreover, limitingdilution analysis may be conducted as previously alluded to above andwill preferably employ the use of Poisson distribution statistics toprovide an accurate accounting as to the reduction of frequency.

In a similar vein the present invention also provides kits or devicesand associated methods that are useful in the diagnosis and monitoringof SEZ6 associated disorders such as cancer. To this end the presentinvention preferably provides an article of manufacture useful fordiagnosing or treating SEZ6 associated disorders comprising a receptaclecomprising a SEZ6 modulator and instructional materials for using saidSEZ6 modulator to treat or diagnose the SEZ6 associated disorder. Inselected embodiments the devices and associated methods will comprisethe step of contacting at least one circulating tumor cell.

Other preferred embodiments of the invention also exploit the propertiesof the disclosed modulators as an instrument useful for identifying,characterizing, isolating, sectioning or enriching populations orsubpopulations of tumor initiating cells through methods such as flowcytometric analysis including fluorescence activated cell sorting (FACS)or laser mediated sectioning.

As such, another preferred embodiment of the instant invention isdirected to a method of identifying, isolating, sectioning or enrichinga population of tumor initiating cells comprising the step of contactingsaid tumor initiating cells with a SEZ6 modulator.

The foregoing is a summary and thus contains, by necessity,simplifications, generalizations, and omissions of detail; consequently,those skilled in the art will appreciate that the summary isillustrative only and is not intended to be in any way limiting. Otheraspects, features, and advantages of the methods, compositions and/ordevices and/or other subject matter described herein will becomeapparent in the teachings set forth herein. The summary is provided tointroduce a selection of concepts in a simplified form that are furtherdescribed below in the Detailed Description. This summary is notintended to identify key features or essential features of the claimedsubject matter, nor is it intended to be used as an aid in determiningthe scope of the claimed subject matter.

BRIEF DESCRIPTION OF THE FIGURES

FIGS. 1A-1E are various representations of SEZ6 including nucleic acidor amino acid sequences pertaining to the SEZ6 modulators describedherein. FIGS. 1A and 1B (SEQ ID NOS: 1 and 2) depict the full lengthmRNA sequence containing the open reading frames (ORFs) (underlined)encoding the SEZ6 variants 1 and 2, respectively. FIGS. 1C and 1D (SEQID NOS: 3 and 4) provide the corresponding amino acid sequences of theORFs denoted in FIGS. 1A and 1B, respectively, with the amino acidresidues indicating the predicted transmembrane spanning domain for eachprotein isoform underlined and the amino acid residues (residues 1-19)indicating the signal peptide in bold and underlined; FIG. 1E depictsthe alignment of the two protein isoforms (SEQ ID NOS: 3 and 4) toillustrate the sequence differences in the cytoplasmic termini of eachisoform, with the underlined residues indicating the differences betweenthe two sequences; and FIG. 1F provides a schematic representation ofthe extracellular region of the SEZ6 protein illustrating the positionsof the various domains.

FIGS. 2A-2C provide a tabular representation of the percent identity atthe protein level between the closest human isoform of SEZ6 and rhesus,cynomolgus, mouse or rat SEZ6 proteins (FIG. 2A); a tabular listing ofvarious cDNA or protein sequence accessions for each of the reportedisoforms of the SEZ6 family of genes (FIG. 2B); and the percent identityat the protein level between the longest isoforms of human SEZ6, SEZ6L,and SEZ6L2 proteins (FIG. 2C).

FIGS. 3A-3C provide various representations of nucleic acid or aminoacid sequences related to the production of the immunogens or cell linesused to generate or characterize the SEZ6 modulators described herein.For human SEZ6 a specific cDNA clone (FIG. 3A; SEQ ID NO: 5) encodingthe complete mature human SEZ6 protein (FIG. 3B; SEQ ID NO: 6) wasconstructed from a commercial cDNA clone (BC146292; SEQ ID NO: 7) withknown differences (FIG. 3C) from a database reference sequence,NP_849191 (SEQ ID NO: 3), for the SEZ6 protein.

FIGS. 4A and 4B provide a cDNA (FIG. 4A; SEQ ID NO: 8) used to expressan Fc-SEZ6 construct in CHO-S cells and yield a protein immunogen (FIG.4B; SEQ ID NO: 9), comprising the ECD of human SEZ6 fused to a humanIgG2 Fc domain, in which the underlined sequences correspond to thehuman IgG2 Fc domain, the double underlined sequences correspond to theIgK signal peptide, and the amino acids in bold font correspond toresidues contributed by the restriction sites used to clone the hSEZ6fragment.

FIGS. 5A-5J provide various representations of nucleic acid or aminoacid sequences related to the production of the immunogens or cell linesused to generate or characterize the SEZ6 modulators described herein,wherein the underlined sequences denote the ECD of protein for thespecific SEZ6 or SEZ6 family member being illustrated, and the figurescomprise the cDNA sequences for the constructs encoding mature murineSEZ6 (FIG. 5A, SEQ ID NO: 10), mature rat SEZ6 (FIG. 5C, SEQ ID NO: 12),mature cynomolgus SEZ6 (FIG. 5E, SEQ ID NO: 14), mature ECD of the humanSEZ6L protein (FIG. 5G, SEQ ID NO:

16), or the mature ECD of the human SEZ6L2 protein (FIG. 5I, SEQ ID NO:18), or the corresponding proteins encoded by these cDNA constructs,namely mature murine SEZ6 (FIG. 5B, SEQ ID NO: 11), mature rat SEZ6(FIG. 5D, SEQ ID NO: 13), mature cynomolgus SEZ6 (FIG. 5F, SEQ ID NO:15), the mature ECD of the human SEZ6L protein (FIG. 5H, SEQ ID NO: 17),or the mature ECD of the human SEZ6L2 protein (FIG. 5J, SEQ ID NO: 19).

FIGS. 6A and 6B are depictions of mRNA expression levels of variousgenes as measured using whole transcriptome (SOLiD) sequencing of mRNAderived from tumor cell subpopulations or normal tissues. FIG. 6A is atabular representation of genes associated with tumors havingneuroendocrine features; and FIG. 6B is a graphical representation ofSEZ6 mRNA expression in normal tissues and several non-traditionalxenograft (NTX) tumors derived from lung cancers.

FIG. 7A-7F depict mRNA expression levels analyzed using microarray. FIG.7A is a graphical representation of unsupervised clustering ofmicroarray profiles for 46 tumor lines and two normal tissues; FIGS. 7Band 7C are tabular representations of normalized intensity valuescorresponding to relative expression levels of selected genes related toneuroendocrine phenotypes (FIG. 7B) or the Notch signaling pathway (FIG.7C) wherein unshaded cells and relatively low numbers indicate little tono expression and darker cells and relatively higher numbers indicatehigher expression levels; FIG. 7D is a graphical representation showingrelative expression levels of HES6 mRNA in various tumors and controltissues as measured using qRT-PCR; FIG. 7E is a tabular representationof normalized intensity values corresponding to relative expressionlevels of selected genes indicative of neurogenesis, neural commitment,or differentiation towards neural fates, with un-shaded cells indicatinglittle to no expression and darker cells indicating higher expressionlevels; and FIG. 7F is a graphical representation of normalizedintensity values corresponding to relative expression of SEZ6 in variousNTX tumor lines.

FIGS. 8A and 8B are graphical representations showing relativeexpression levels of SEZ6 mRNA transcripts as measured by RT-PCR in avariety of RNA samples isolated from normal tissues or bulkneuroendocrine NTX tumors (FIG. 8A) and a variety of other NTX tumors(FIG. 8B).

FIGS. 9A and 9B are graphical representations showing the absolute (FIG.9A) or normalized (FIG. 9B) mRNA expression levels of human SEZ6 asmeasured by RT-PCR in whole tumor specimens (grey dot) or matched normaladjacent tissue (NAT; white dot) from patients with one of eighteendifferent solid tumor types.

FIGS. 10A-10B provide the continuous amino acid sequences of light (FIG.10A) and heavy chain (FIG. 10B) variable regions of a number of murineand humanized exemplary

SEZ6 modulators isolated, cloned and engineered as described in theExamples herein. The corresponding nucleic acid sequences are set forthin the appended sequence listing. FIG. 10C sets out the full lengthamino acid sequences of the light and heavy chains of the humanizedantibodies SC17.200 and SC17.200vL1.

FIGS. 11A and 11B set forth various characteristics of exemplarymodulators of the invention. FIG. 11A shows the biochemical andimmunological properties of exemplary SEZ6 modulators as represented ina tabular format; and FIG. 11B provides a correlation between the domainto which an antibody binds and the antibody's efficacy in an in vitrokilling assay.

FIGS. 12A and 12B show detection of expression of SEZ6 protein measuredusing an electrochemiluminescent assay. FIG. 12A shows SEZ6 expressionin HEK-293T cells engineered to over-express human SEZ6 protein(h293T-HuSEZ6) using the anti-SEZ6 antibody SC17.33; FIG. 12B shows therelative protein expression of human SEZ6 in various NTX tumor andnormal tissue lysates.

FIGS. 13A and 13B show detection by flow cytometry of SEZ6 proteinexpression on NTX tumor cells using various anti-SEZ6 antibodies (FIG.13A); whereas FIG. 13B shows enhanced expression of SEZ6 protein in CSCscompared to NTG subpopulations using various anti-SEZ6 antibodies (FIG.13B).

FIGS. 14A and 14B show that CSCs expressing SEZ6 exhibit enhancedtumorigenicity compared to CSCs that do not express SEZ6. FIG. 14A is acontour plot showing cell sorting by FACS of the cells in a lung tumor(LU37) on the basis of expression of CD324 (a marker of CSCs) and SEZ6;FIG. 14B is a graphical representation of the growth of tumor cells thatare either CD324⁺SEZ6⁺ (black circles) or CD324⁺SEZ6⁻ (white circles)after implantation into immunocompromised mice. Tumor cells expressingboth CD324 and SEZ6 exhibit enhanced tumorigenicity.

FIGS. 15A and 15B provide, respectively, a tabular and graphicalrepresentation illustrating that the disclosed modulators mayeffectively be used as targeting moieties to direct cytotoxic payloadsto cells engineered to express SEZ6 (FIG. 15A) and NTX lung tumors(LU80, LU37 and LU100) grown in vitro (FIG. 15B) where the decrease innormalized relative luminescence units (RLU) is indicative of cellkilling through internalization of the saporin toxin.

FIGS. 16A-16C show the quantification of SEZ6 expression in various SCLCand medullary thyroid tumors determined using immunohistochemistry(IHC), where FIG. 16A shows SEZ6 expression in NTX SCLC tumors, FIG. 16Bshows SEZ6 expression in SCLC tumor microarrays and FIG. 16C shows SEZ6expression in primary medullary thyroid tumors.

FIGS. 17A-17B depict the ability of conjugated anti-SEZ6 mouseantibodies to retard in vitro and in vivo growth of NTX tumor cells.FIG. 17A shows the results of an in vitro killing assay using anti-SEZ6ADCs on SCLC (LU64) and OV (OV26) NTX tumor cell lines; whereas FIG. 17Bshows the effect of anti-SEZ6 ADCs on growth of SCLC (LU86) and LCNEC(LUSO) tumors in vivo.

FIGS. 18A-18D depict the ability of conjugated humanized anti-SEZ6antibodies to retard growth of a thyroid cell line in vitro (FIG. 18A)and in vivo (FIG. 18B); and to retard growth of four SCLC tumors in vivo(LU80, LU64, LU111 and LU117) and achieve durable remission inimmunodeficient mice (FIGS. 18C and 18D).

FIG. 19 shows dose response curves of oxalaplatin in the parental smallcell lung cancer (SCLC) patient-derived xenograft (PDX) line, LU124p2compared to the oxalaplatin-resistant cell line LU124OXAHIp2 andLU124OXAHIp3.

FIG. 20 shows mRNA expression of SEZ6 in parental SCLC PDX lines LU124p1and LU124p3, and in oxalaplatin-resistant cell line LU124OXAHIp3.

FIG. 21 shows protein expression of SEZ6 in in parental SCLC PDX lineLU124p3 and in oxalaplatin-resistant cell line LU124OXAHIp3.

DETAILED DESCRIPTION OF THE INVENTION I. Introduction

While the present invention may be embodied in many different forms,disclosed herein are specific illustrative embodiments thereof thatexemplify the principles of the invention. It should be emphasized thatthe present invention is not limited to the specific embodimentsillustrated. Moreover, any section headings used herein are fororganizational purposes only and are not to be construed as limiting thesubject matter described. Finally, for the purposes of the instantdisclosure all identifying sequence Accession numbers may be found inthe NCBI Reference Sequence (RefSeq) database and/or the NCBI GenBank°archival sequence database unless otherwise noted.

As previously alluded to, it has surprisingly been found that theexpression of SEZ6 is associated with neoplastic growth andproliferative disorders, particularly in the instance of tumors withneuroendocrine features, and that SEZ6 and variants or isoforms thereofprovide useful tumor markers which may be exploited in the treatment ofrelated diseases. Moreover, as shown in the instant application it hasunexpectedly been found that SEZ6 markers or determinants such as cellsurface SEZ6 protein are associated with cancer stem cells (also knownas tumor perpetuating cells) and may be effectively exploited toeliminate or silence the same. The ability to selectively reduce oreliminate cancer stem cells (e.g., through the use of conjugated SEZ6modulators) is particularly surprising in that such cells are known togenerally be resistant to many conventional treatments. That is, theeffectiveness of traditional, as well as more recent targeted treatmentmethods, is often limited by the existence and/or emergence of resistantcancer stem cells that are capable of perpetuating the cancer even inthe face of these diverse treatment methods. Further, determinantsassociated with cancer stem cells often make poor therapeutic targetsdue to low or inconsistent expression, failure to remain associated withthe tumorigenic cell or failure to present at the cell surface. In sharpcontrast to the teachings of the prior art, the instantly disclosedcompounds and methods effectively overcome this inherent resistance tospecifically eliminate, deplete, silence or promote the differentiationof such cancer stem cells thereby negating their ability to sustain orre-induce the underlying tumor growth.

More specifically, it has been discovered that SEZ6 modulators such asthose disclosed herein may advantageously be used in the prognosis,diagnosis, theragnosis, treatment or prevention of proliferativedisorders (e.g. neoplastic disorders) in subjects in need thereof.Accordingly, while preferred embodiments of the invention will bediscussed extensively below, particularly in terms of particulardomains, regions or epitopes or in the context of cancer stem cells ortumors comprising neuroendocrine features and their interactions withthe disclosed modulators, those skilled in the art will appreciate thatthe scope of the instant invention is not limited by such exemplaryembodiments. Rather, the most expansive embodiments of the presentinvention and the appended claims are broadly and expressly directed toSEZ6 modulators (including conjugated modulators) and their use in theprognosis, diagnosis, theragnosis, treatment or prevention of a varietyof SEZ6 associated or mediated disorders, including neoplastic orproliferative disorders, regardless of any particular mechanism ofaction or specifically targeted tumor, cellular or molecular component.

To that end, and as demonstrated in the instant application, it hasunexpectedly been found that the disclosed SEZ6 modulators caneffectively be used to target and eliminate or otherwise incapacitateproliferative or tumorigenic cells and treat SEZ6 associated disorders(e.g., neoplasia). As used herein a “SEZ6 associated disorder” shall beheld to mean any disorder or disease (including proliferative disorders)that is marked, diagnosed, detected or identified by a phenotypic orgenotypic aberration of SEZ6 genetic components or expression during thecourse or etiology of the disease or disorder. In this regard a SEZ6phenotypic aberration or determinant may, for example, comprise elevatedor depressed levels of SEZ6 protein expression, abnormal SEZ6 proteinexpression on certain definable cell populations or abnormal SEZ6protein expression at an inappropriate phase or stage of a celllifecycle. Of course, it will be appreciated that similar expressionpatterns of genotypic determinants (e.g., mRNA transcription levels) ofSEZ6 may also be used to classify or detect SEZ6 associated disorders.

As used herein the term “determinant” or “SEZ6 determinant” shall meanany detectable trait, property, marker or factor that is identifiablyassociated with, or specifically found in or on a particular cell, cellpopulation or tissue including those identified in or on a tissue, cellor cell population affected by a SEZ6 associated disease or disorder. Inselected preferred embodiments the SEZ6 modulators may associate, bindor react directly with the SEZ6 determinant (e.g., cell surface SEZ6protein or SEZ6 mRNA) and thereby ameliorate the disorder. Moregenerally determinants may be morphological, functional or biochemicalin nature and may be genotypic or phenotypic. In other preferredembodiments the determinant is a cell surface antigen or geneticcomponent that is differentially or preferentially expressed (or is not)by specific cell types (e.g., cancer stem cells) or by cells undercertain conditions (e.g., during specific points of the cell cycle orcells in a particular niche). In still other preferred embodiments thedeterminant may comprise a gene or genetic entity that is differentlyregulated (up or down) in a specific cell or discrete cell population, agene that is differentially modified with regard to its physicalstructure and chemical composition or a protein or collection ofproteins physically associated with a gene that show differentialchemical modifications. Determinants contemplated herein arespecifically held to be positive or negative and may denote a cell, cellsubpopulation or tissue (e.g., tumors) by its presence (positive) orabsence (negative).

In a similar vein “SEZ6 modulators” of the invention broadly compriseany compound that recognizes, reacts, competes, antagonizes, interacts,binds, agonizes, or associates with a SEZ6 variant or isoform (orspecific domains, regions or epitopes thereof) or its genetic component.By these interactions, the SEZ6 modulators may advantageously eliminate,reduce or moderate the frequency, activity, recurrence, metastasis ormobility of tumorigenic cells (e.g., tumor perpetuating cells or cancerstem cells). Exemplary modulators disclosed herein comprise nucleotides,oligonucleotides, polynucleotides, peptides or polypeptides. In certainpreferred embodiments the selected modulators will comprise antibodiesto a SEZ6 protein isoform or immunoreactive fragments or derivativesthereof. Such antibodies may be antagonistic or agonistic in nature andmay optionally be conjugated or associated with a therapeutic ordiagnostic agent. Moreover, such antibodies or antibody fragments maycomprise depleting, neutralizing or internalizing antibodies. In otherembodiments, modulators within the instant invention will constitute aSEZ6 construct comprising a SEZ6 isoform or a reactive fragment thereof.It will be appreciated that such constructs may comprise fusion proteinsand can include reactive domains from other polypeptides such asimmunoglobulins or biological response modifiers. In still otheraspects, the SEZ6 modulator will comprise a nucleic acid moiety (e.g.miRNA, siRNA, shRNA, antisense constructs, etc.) that exerts the desiredeffects at a genomic level. Still other modulators compatible with theinstant teachings will be discussed in detail below.

More generally SEZ6 modulators of the present invention broadly compriseany compound that recognizes, reacts, competes, antagonizes, interacts,binds, agonizes, or associates with a SEZ6 determinant (genotypic orphenotypic) including cell surface SEZ6 protein. Whichever form ofmodulator is ultimately selected it will preferably be in an isolatedand purified state prior to introduction into a subject. In this regardthe term “isolated SEZ6 modulator” or “isolated SEZ6 antibody” shall beconstrued in a broad sense and in accordance with standardpharmaceutical practice to mean any preparation or compositioncomprising the modulator in a state substantially free of unwantedcontaminants (biological or otherwise). Moreover these preparations maybe purified and formulated as desired using various art recognizedtechniques. Of course, it will be appreciated that such “isolated”preparations may be intentionally formulated or combined with inert oractive ingredients as desired to improve the commercial, manufacturingor therapeutic aspects of the finished product and providepharmaceutical compositions. In a broader sense the same generalconsiderations may be applied to an “isolated” SEZ6 isoform or variantor an “isolated” nucleic acid encoding the same.

Further, it has surprisingly been found that modulators interacting,associating or binding to particular SEZ6 domains, motifs or epitopesare especially effective in eliminating tumorigenic cells and/orsilencing or attenuating cancer stem cell effects on tumor growth orpropagation. That is, while modulators that react or associate withdomains that are proximal to the cell surface (e.g. one of the Sushi orCUB-like domains) are effective in depleting or neutralizing tumorigeniccells it has unexpectedly been discovered that modulators associating orbinding to domains, motifs or regions that are relatively more distal tothe cell surface are also effective in eliminating, neutralizing,depleting or silencing tumorigenic cells. This is especially true ofconjugated modulators such as, for example, anti-SEZ6 antibody drugconjugates comprising a cytotoxic agent.

While the present invention expressly contemplates the use of any SEZ6modulator in the treatment of any SEZ6 disorder, including any type ofneoplasia, in particularly preferred embodiments the disclosedmodulators may be used to prevent, treat or diagnose tumors comprisingneuroendocrine features (genotypic or phenotypic) includingneuroendocrine tumors. True or “canonical neuroendocrine tumors” (NETs)arise from the dispersed endocrine system and are typically highlyaggressive. Neuroendocrine tumors occur in the kidney, genitourinarytract (bladder, prostate, ovary, cervix, and endometrium),gastrointestinal tract (stomach, colon), thyroid (medullary thyroidcancer), and lung (small cell lung carcinoma and large cellneuroendocrine carcinoma). Moreover, the disclosed modulators mayadvantageously be used to treat, prevent or diagnose pseudoneuroendocrine tumors (pNETs) that genotypically or phenotypicallymimic, comprise, resemble or exhibit common traits with canonicalneuroendocrine tumors. “Pseudo neuroendocrine tumors” are tumors thatarise from cells of the diffuse neuroendocrine system or from cells inwhich a neuroendocrine differentiation cascade has been aberrantlyreactivated during the oncogenic process. Such pNETs commonly sharecertain genotypic, phenotypic or biochemical characteristics withtraditionally defined neuroendocrine tumors, including the ability toproduce subsets of biologically active amines, neurotransmitters, andpeptide hormones. Accordingly, for the purposes of the instant inventionthe phrases “tumors comprising neuroendocrine features” or “tumorsexhibiting neuroendocrine features” shall be held to comprise bothneuroendocrine tumors and pseudo neuroendocrine tumors unless otherwisedictated by context.

In preferred embodiments the disclosed modulators will be used to treatsmall cell lung cancer and, in particularly preferred embodiments, willbe used to treat platinum resistant small cell lung cancer in a subjectin need thereof. As used herein and known in the art, the term “platinumresistant small cell lung cancer” means the presence of tumors ortumorigenic small cell lung cancer cells in a subject that are resistantor refractory to treatment with standard of care platinum based agentssuch as carboplatin, cisplatin and/or oxalaplatin. Such conditions arereadily diagnosed using standard clinical procedures and theirrecognition is well with the purview of a clinician of ordinary skill inthe art.

Besides the association with tumors generally discussed above, there arealso indications of phenotypic or genotypic association between selectedtumor initiating cells (TIC) and SEZ6 determinants. In this regardselected TICs (e.g., cancer stem cells) may express elevated levels ofSEZ6 proteins when compared to normal tissue and non-tumorigenic cells(NTG), which together typically comprise much of a solid tumor. Thus,SEZ6 determinants may comprise a tumor associated marker (or antigen orimmunogen) and the disclosed modulators may provide effective agents forthe detection and suppression of TIC and associated neoplasia due toaltered levels of the proteins on cell surfaces or in the tumormicroenvironment. Accordingly, SEZ6 modulators, including immunoreactiveantagonists and antibodies that associate, bind or react with theproteins, may effectively reduce the frequency of tumor initiating cellsand could be useful in eliminating, depleting, incapacitating, reducing,promoting the differentiation of, or otherwise precluding or limitingthe ability of these tumor-initiating cells to lie dormant and/orcontinue to fuel tumor growth, metastasis or recurrence in a patient. Inthis regard those skilled in the art will appreciate that the presentinvention further provides SEZ6 modulators and their use in reducing thefrequency of tumor initiating cells.

II. SEZ6 Physiology

SEZ6 (also known as seizure related 6 homolog) is a type I transmembraneprotein originally cloned from mouse cerebrum cortex-derived cellstreated with the convulsant pentylentetrazole (Shimizu-Nishikawa, 1995;PMID: 7723619). Representative SEZ6 protein orthologs include, but arenot limited to, human (NP_849191; NP_001092105), chimpanzee (XP_511368,NP_001139913), mouse (NP_067261), and rat (NP_001099224). In humans, theSEZ6 gene consists of 17 exons spanning 51.1 kBp located on chromosome17q11.2. Alternate splice acceptor sites only 16 base pairs apart withinthe last exon gives rise to two processed transcripts, one ofapproximately 4210 bases (NM_178860; FIG. 1A) and one of approximately4194 bases (NM_001098635, FIG. 1B). The former transcript encodes a 994amino acid protein (NP_849191; FIG. 1C), whereas the latter encodes a993 amino acid protein (NP_001092105; FIG. 1D). These two proteinisoforms of SEZ6 share overall 100% identity across their extracellulardomains and their transmembrane domains, differing only in the final tenamino acid residues (FIG. 1E). A third splice variant has been reportedto generate a secreted from of SEZ6 (Shimizu-Nishikawa, 1995; PMID:7723619), however it has not been included in the RefSeqs associatedwithin the NCBI database Gene page entry. The modulators of theinvention may bind to any of the splice variants.

The biological relevance of the isoforms is unclear, although one studyhas suggested opposing actions for the membrane versus soluble proteinswhen their expression is restored in neurons from murine SEZ6 knockoutmice (Gunnersen et al. 2007, PMID: 18031681). Cross species proteinsequence identity for the SEZ6 proteins are listed in FIG. 2A. In thehuman genome, there are two closely related genes-seizure related 6homolog-like (SEZ6L) and seizure related 6 homolog like-2 (SEZ6L2), eachof which has multiple splice variants encoding numerous isoforms (FIG.2B). Percent identities for the longest protein of each of the membersof this family of SEZ6-like proteins in humans are shown in FIG. 2C.Taken together SEZ6, SEZ6L and SEZ6L2, including their various isoforms,will be termed the SEZ6 family for the purposes of the instantapplication. SEZ6 modulators of the invention comprise modulators thatare specific for each of SEZ6, SEZ6L or SEZ6L2. Alternatively, themodulators of the invention may cross react with SEZ6 and one or both ofSEZ6L and/or SEZ6L2.

The mature SEZ6 protein is composed of a series of structural domains: acytoplasmic domain, a transmembrane domain and an extracellular domaincomprising a unique N-terminal domain, followed by two alternating Sushiand CUB-like domains, and three additional tandem Sushi domain repeats.Two isoforms of the SEZ6 antigen exist, and differ only on the extremecarboxy terminal, cytoplasmic domain.

FIG. 1F provides a schematic diagram of the extracellular region of theSEZ6 protein, illustrating the general juxtaposition of the Sushi andCUB domains, and the N-terminal domain. Generally, the domains arerecognized as occurring at about amino acid residues 336-395 (SushiDomain 1), 397-508 (CUB Domain 1), 511-572 (Sushi Domain 2), 574-685(CUB Domain 2), 690-748 (Sushi Domain 3), 750-813 (Sushi Domain 4),817-878 (Sushi Domain 5), with the N terminal domain at about amino acidresidues 1-335, and a compositional bias of proline-rich residues atabout amino acid residues 71-169.

The Sushi repeats are similar to the short consensus repeats found inthe other human complement regulatory proteins (i.e., complement C3b/C4bbinding sites). The CUB-like domains are similar to CUB domains found inother mammalian complement binding proteins which are associated with awide range of proteins that participate in numerous biological processesother than complement activation, including but not limited topatterning, axon guidance, inflammation, and tumor suppression (Bork andBeckman, 1993, PMID: 8510165). Both the Sushi and CUB domains imply afunction for SEZ6 involving binding of other proteins extracellularly.Proteins containing CUB domains also have been linked to cell signalingpathways, and consistent with this function, the SEZ6 C-terminalcytoplasmic domains contain the Asn-Pro-Thr-Tyr motif (SEQ ID NO: 200),which is a potential target for phosphorylation by Src tyrosine kinasefamily members. If true, this would link SEZ6 to a cellular signaltransduction pathway leading to the activation of Ras, suggesting thatSEZ6 may be a neurotrophic receptor.

Note that, the terms “mature protein” or “mature polypeptide” as usedherein refers to the form(s) of the SEZ6 protein produced without thesignal peptide of 19 amino acids that may be cleaved prior to cellsurface expression. Unless otherwise indicated SEZ6 amino acid numbering(for domains, regions, epitopes, etc.) will be in the context of amature protein without the leader.

SEZ6 is detectable by RT-PCR at low levels in kidney, liver, heart, lungand thymus of rodents, although strong protein expression was seen onlyin brain, with a significant level expressed in testis (Herbst andNicklin, 1997, PMID: 9073173). Using polyclonal sera to SEZ6, proteinexpression was detected in day 13 of developing mouse forebrain. Strongstaining was detected in the post-mitotic, maturing neurons of thedeveloping cortical plate and sub-plate. This staining is diminished inthe adult brain where the SEZ6 expression can be detected in other brainregions associated with ongoing morphological plasticity, such as thehippocampus, cerebellum, and olfactory bulb and in neurons of the retinaand spinal cord (Gunnersen et al., 2007, PMID: 18031681). The densestsignals are found in regions with greatest concentration of neuronalcell bodies. In spite of widespread retinal expression of SEZ6, retinalfunction in the absence of SEZ6 was not affected (Gunnersen et al.,2009, PMID: 19662096). The SEZ6 staining pattern is closely tied withthe emergence of the neocortical layers and hippocampus, and implies aforebrain-specific role for this gene during development. In human andmice SEZ6 was found to be differentially expressed in highly specificregions of the neocortex (Gunnersen et al., 2007, supra).

Mutations in the human SEZ6 gene have been linked to febrile seizures(FS), a convulsion associated with a rise in body temperature and themost common type of seizure in childhood (Yu et al., 2007,PMID:17086543). FS may be classified as simple or complex, dependingupon duration, recurrence, and extent of the body affected by theseizure. In a Chinese cohort, no mutations in SEZ6 were found in 15healthy controls, but mutations were found in 21 of 60 patients with FS,with the most common type of mutation being a heterozygous, cytosineinsertion (frame shift mutation) at position 1435 of the cDNA. Themutation incidence was significantly higher in patients with complex FSand in patients with a positive family history. As there is an 80%chance that children with complex FS will have seizures later in life,the authors suggest that screening for mutations in SEZ6 may be valuablein predicting FS recurrence or the development of epilepsy (Yu et al.,2007, supra). Later studies have questioned the incidence, relevance,and ability of this study to have adequate power to imply causality, butdo support that SEZ6 may be one gene among many that may play a role inseizure disorders (Mulley et al., 2011, PMID: 21785725).

The specific molecular functions of SEZ6 remain unclear. As discussedabove, analysis of the structural modules of the protein identified byhomology and sequence analysis suggest a possible role in signaling,cell-cell communication, and neural development. The neuronal dendriticbranching and connectivity that form the signaling networks thatconstitute the brain's circuitry arise and are specified both byintrinsic molecular programs in the neural cell as well as extrinsicsignals. The process of dendritic growth in pyramidal neurons, theprincipal neuron in the mammalian forebrain, yields neurons withdistinctive morphologies—a pyramidal cell body, and two distinct,complex dendritic trees: one emerging from the apex and the other fromthe base of the cell body. Gunnersen et al. (2007, supra) have shownthat SEZ6 null mice exhibit an excess of short dendrites in thedendritic trees of these neurons, yet display no increase in the overalldendritic field, the range of neurons with which a given neuronconnects. Restoring the expression of the membrane bound SEZ6 isoformsin the knockout neurons results in an anti-branching effect. Inbehavioral tests the SEZ6 null mice display specific exploratory, motor,and cognitive deficits. These data suggest that SEZ6 is important forthe achievement of the necessary balance between dendrite elongation andbranching during the elaboration of a complex dendritic arbor duringdevelopment.

Together, the studies above strongly suggest that the SEZ6 protein isimportant in the context of neural development, and is likely to havesome role in cell-cell communication and signaling. Inappropriatereactivation of developmental signaling pathways or disregulation ofnormal signaling pathways are commonly observed in tumors (Harris etal., 2012). One collection of tumors sharing features indicative ofpartial reactivation of developmental programs are tumors withneuroendocrine phenotypes (Yao 2008; PMID: 18565894), in which varioushormone and endocrine markers are expressed and/or secreted, and variousneural markers indicative of neurogenesis, neural commitment, ordifferentiation towards neural fates are expressed. Tumors withneuroendocrine features arise infrequently in a wide range of primarysites, and while their exhaustive classification remains problematic(Yao; PMID: 18565894; Klimstra 2010; PMID: 20664470; Klöppel, 2011;PMID: 22005112), they may be classified into four major types: low gradebenign carcinoids, low-grade well-differentiated neuroendocrine tumorswith malignant behavior, tumors with mixed neuroendocrine and epithelialfeatures, and high-grade poorly differentiated neuroendocrinecarcinomas. Of these classifications, the poorly differentiatedneuroendocrine carcinomas, which include small cell lung cancer (SCLC)and subsets of non-small cell lung cancer (NSCLC), are cancer types withdismal prognoses. It has been postulated that SCLC is bronchogenic inorigin, arising in part from pulmonary neuroendocrine cells (Galluzzoand Bocchetta, 2011; PMID: 21504320). Whatever the cellular source oforigin for these tumors, it is clear that they show a poorlydifferentiated endocrine phenotype, often are highly proliferative andaggressive, and frequently over-express neural proteins. Similarly,medullary thyroid cancers (MTC), a special neuroendocrine tumor typethat arises from the calcitonin-secreting parafollicular C cells of thethyroid, show neuroendocrine phenotypes consistent with both theirmature endocrine function and their derivation from neural crest tissue(Cook et al., 2010; PMID: 20182588). While representing only about 3-5%of thyroid cancers, MTC results in up to 14% of all thyroid cancerdeaths, is not very responsive to standard chemotherapy or radiationtreatments, and even with newer molecularly targeted tyrosine kinaseinhibitors such as cabozantinib and vandetanib, responds poorly tomonotherapies (Haddad, 2013; PMID: 24002516). Given these examples oftumors with dismal prognoses, the resultant elevation of neuralexpression markers in these tumors that otherwise may be primarilyrestricted to the nervous system or show limited expression duringdevelopment, of which SEZ6 may be an exemplar, may therefore offer aunique therapeutic target for tumors with the neuroendocrine phenotype.

III. Cancer Stem Cells

As alluded to above it has surprisingly been discovered that aberrantSEZ6 expression (genotypic and/or phenotypic) is associated with varioustumorigenic cell subpopulations. In this respect the present inventionprovides SEZ6 modulators that may be particularly useful for targetingsuch cells, and especially tumor perpetuating cells, therebyfacilitating the treatment, management or prevention of neoplasticdisorders. Thus, in preferred embodiments modulators of SEZ6determinants (phenotypic or genotypic) may be advantageously be used toreduce tumor initiating cell frequency in accordance with the presentteachings and thereby facilitate the treatment or management ofproliferative disorders.

For the purposes of the instant application the term “tumor initiatingcell” (TIC) encompasses both “tumor perpetuating cells” (TPC; i.e.,cancer stem cells or CSC) and highly proliferative “tumor progenitorcells” (termed TProg), which together generally comprise a uniquesubpopulation (i.e. 0.1-40%) of a bulk tumor or mass. For the purposesof the instant disclosure the terms “tumor perpetuating cells” and“cancer stem cells” or “neoplastic stem cells” are equivalent and may beused interchangeably herein. TPC differ from TProg in that TPC cancompletely recapitulate the composition of tumor cells existing within atumor and have unlimited self-renewal capacity as demonstrated by serialtransplantation (two or more passages through mice) of low numbers ofisolated cells, whereas TProg will not display unlimited self-renewalcapacity.

Those skilled in the art will appreciate that fluorescence-activatedcell sorting (FACS) using appropriate cell surface markers is a reliablemethod to isolate highly enriched cancer stem cell subpopulations(e.g., >99.5% purity) due, at least in part, to its ability todiscriminate between single cells and clumps of cells (i.e. doublets,etc.). Using such techniques it has been shown that when low cellnumbers of highly purified TProg cells are transplanted intoimmunocompromised mice they can fuel tumor growth in a primarytransplant. However, unlike purified TPC subpopulations the TProggenerated tumors do not completely reflect the parental tumor inphenotypic cell heterogeneity and are demonstrably inefficient atreinitiating serial tumorigenesis in subsequent transplants. Incontrast, TPC subpopulations completely reconstitute the cellularheterogeneity of parental tumors and can efficiently initiate tumorswhen serially isolated and transplanted. Thus, those skilled in the artwill recognize that a definitive difference between TPC and TProg,though both may be tumor generating in primary transplants, is theunique ability of TPC to perpetually fuel heterogeneous tumor growthupon serial transplantation at low cell numbers. Other common approachesto characterize TPC involve morphology and examination of cell surfacemarkers, transcriptional profile, and drug response although markerexpression may change with culture conditions and with cell line passagein vitro.

Accordingly, for the purposes of the instant invention tumorperpetuating cells, like normal stem cells that support cellularhierarchies in normal tissue, are preferably defined by their ability toself-renew indefinitely while maintaining the capacity for multilineagedifferentiation. Tumor perpetuating cells are thus capable of generatingboth tumorigenic progeny (i.e., tumor initiating cells: TPC and TProg)and non-tumorigenic (NTG) progeny. As used herein a “non-tumorigeniccell” (NTG) refers to a tumor cell that arises from tumor initiatingcells, but does not itself have the capacity to self-renew or generatethe heterogeneous lineages of tumor cells that comprise a tumor.Experimentally, NTG cells are incapable of reproducibly forming tumorsin mice, even when transplanted in excess cell numbers.

As indicated, TProg are also categorized as tumor initiating cells (orTIC) due to their limited ability to generate tumors in mice. TProg areprogeny of TPC and are typically capable of a finite number ofnon-self-renewing cell divisions. Moreover, TProg cells may further bedivided into early tumor progenitor cells (ETP) and late tumorprogenitor cells (LTP), each of which may be distinguished by phenotype(e.g., cell surface markers) and different capacities to recapitulatetumor cell architecture. In spite of such technical differences, bothETP and LTP differ functionally from TPC in that they are generally lesscapable of serially reconstituting tumors when transplanted at low cellnumbers and typically do not reflect the heterogeneity of the parentaltumor. Notwithstanding the foregoing distinctions, it has also beenshown that various TProg populations can, on rare occasion, gainself-renewal capabilities normally attributed to stem cells andthemselves become TPC (or CSC). In any event both types oftumor-initiating cells are likely represented in the typical tumor massof a single patient and are subject to treatment with the modulators asdisclosed herein. That is, the disclosed compositions are generallyeffective in reducing the frequency or altering the chemosensitivity ofsuch SEZ6 positive tumor initiating cells regardless of the particularembodiment or mix represented in a tumor.

In the context of the instant invention, TPC are more tumorigenic,relatively more quiescent and often more chemoresistant than the TProg(both ETP and LTP), NTG cells and the tumor-infiltrating non-TPC derivedcells (e.g., fibroblasts/stroma, endothelial & hematopoietic cells) thatcomprise the bulk of a tumor. Given that conventional therapies andregimens have, in large part, been designed to both debulk tumors andattack rapidly proliferating cells, TPC are likely to be more resistantto conventional therapies and regimens than the faster proliferatingTProg and other bulk tumor cell populations. Further, TPC often expressother characteristics that make them relatively chemoresistant toconventional therapies, such as increased expression of multi-drugresistance transporters, enhanced DNA repair mechanisms andanti-apoptotic proteins. These properties, each of which contribute todrug tolerance by TPC, constitute a key reason for the failure ofstandard oncology treatment regimens to ensure long-term benefit formost patients with advanced stage neoplasia; i.e. the failure toadequately target and eradicate those cells that fuel continued tumorgrowth and recurrence (i.e. TPC or CSC).

Unlike many prior art treatments, the novel compositions of the presentinvention preferably reduce the frequency of tumor initiating cells uponadministration to a subject regardless of the form or specific target(e.g., genetic material, SEZ6antibody or ligand fusion construct) of theselected modulator. As noted above, the reduction in tumor initiatingcell frequency may occur as a result of a) elimination, depletion,sensitization, silencing or inhibition of tumor initiating cells; b)controlling the growth, expansion or recurrence of tumor initiatingcells; c) interrupting the initiation, propagation, maintenance, orproliferation of tumor initiating cells; or d) by otherwise hinderingthe survival, regeneration and/or metastasis of the tumorigenic cells.In some embodiments, the reduction in the frequency of tumor initiatingcells occurs as a result of a change in one or more physiologicalpathways. The change in the pathway, whether by reduction or eliminationof the tumor initiating cells or by modifying their potential (e.g.,induced differentiation, niche disruption) or otherwise interfering withtheir ability to influence the tumor environment or other cells, in turnallows for the more effective treatment of SEZ6 associated disorders byinhibiting tumorigenesis, tumor maintenance and/or metastasis andrecurrence.

Among art-recognized methods that can be used to assess such a reductionin the frequency of tumor initiating cells is limiting dilution analysiseither in vitro or in vivo, preferably followed by enumeration usingPoisson distribution statistics or assessing the frequency of predefineddefinitive events such as the ability to generate tumors in vivo or not.While such limiting dilution analysis comprise preferred methods ofcalculating reduction of tumor initiating cell frequency other, lessdemanding methods, may also be used to effectively determine the desiredvalues, albeit slightly less accurately, and are entirely compatiblewith the teachings herein. Thus, as will be appreciated by those skilledin the art, it is also possible to determine reduction of frequencyvalues through well-known flow cytometric or immunohistochemical means.As to all the aforementioned methods see, for example, Dylla et al.2008, PMID: 18560594 & Hoey et al. 2009, PMID: 19664991; each of whichis incorporated herein by reference in its entirety and, in particular,for the disclosed methods.

With respect to limiting dilution analysis, in vitro enumeration oftumor initiating cell frequency may be accomplished by depositing eitherfractionated or unfractionated human tumor cells (e.g. from treated anduntreated tumors, respectively) into in vitro growth conditions thatfoster colony formation. In this manner, colony forming cells might beenumerated by simple counting and characterization of colonies, or byanalysis consisting of, for example, the deposition of human tumor cellsinto plates in serial dilutions and scoring each well as either positiveor negative for colony formation at least 10 days after plating. In vivolimiting dilution experiments or analyses, which are generally moreaccurate in their ability to determine tumor initiating cell frequencyencompass the transplantation of human tumor cells, from eitheruntreated control or treated populations, for example, intoimmunocompromised mice in serial dilutions and subsequently scoring eachmouse as either positive or negative for tumor formation at least 60days after transplant. The derivation of cell frequency values bylimiting dilution analysis in vitro or in vivo is preferably done byapplying Poisson distribution statistics to the known frequency ofpositive and negative events, thereby providing a frequency for eventsfulfilling the definition of a positive event; in this case, colony ortumor formation, respectively.

As to other methods compatible with the instant invention that may beused to calculate tumor initiating cell frequency, the most commoncomprise quantifiable flow cytometric techniques and immunohistochemicalstaining procedures. Though not as precise as the limiting dilutionanalysis techniques described immediately above, these procedures aremuch less labor intensive and provide reasonable values in a relativelyshort time frame. Thus, it will be appreciated that a skilled artisanmay use flow cytometric cell surface marker profile determinationemploying one or more antibodies or reagents that bind art-recognizedcell surface proteins known to enrich for tumor initiating cells (e.g.,potentially compatible markers as are set forth in PCT application2012/031280 which is incorporated herein in its entirety) and therebymeasure TIC levels from various samples. In still another compatiblemethod one skilled in the art might enumerate TIC frequency in situ(e.g., in a tissue section) by immunohistochemistry using one or moreantibodies or reagents that are able to bind cell surface proteinsthought to demarcate these cells.

Those skilled in the art will recognize that numerous markers (or theirabsence) have been associated with various populations of cancer stemcells and used to isolate or characterize tumor cell subpopulations. Inthis respect exemplary cancer stem cell markers comprise OCT4, Nanog,STAT3, EPCAM, CD24, CD34, NB84, TrkA, GD2, CD133, CD20, CD56, CD29,B7H3, CD46, transferrin receptor, JAM3, carboxypeptidase M, ADAM9,oncostatin M, Lgr5, Lgr6, CD324, CD325, nestin, Sox1, Bmi-1, eed,easyh1, easyh2, mf2, yy1, smarcA3, smarckA5, smarcD3, smarcEl, mllt3,FZD1, FZD2, FZD3, FZD4, FZD6, FZD7, FZD8, FZD9, FZD10, WNT2, WNT2B,WNT3, WNT5A, WNT10B, WNT16, AXIN1, BCL9, MYC, (TCF4) SLC7A8, IL1RAP,TEM8, TMPRSS4, MUC16, GPRCSB, SLC6A14, SLC4A11, PPAP2C, CAV1, CAV2,PTPN3, EPHA1, EPHA2, SLC1A1, CX3CL1, ADORA2A, MPZL1, FLJ10052, C4.4A,EDG3, RARRES1, TMEPAI, PTS, CEACAM6, NID2, STEAP, ABCA3, CRIM1, IL1R1,OPN3, DAF, MUC1, MCP, CPD, NMA, ADAM9, GJA1, SLC19A2, ABCA1, PCDH7,ADCY9, SLC39A1, NPC1, ENPP1, N33, GPNMB, LY6E, CELSR1, LRP3, C20orf52,TMEPAI, FLVCR, PCDHA10, GPR54, TGFBR3, SEMA4B, PCDHB2, ABCG2, CD166,AFP, BMP-4, β-catenin, CD2, CD3, CD9, CD14, CD31, CD38, CD44, CD45,CD74, CD90, CXCR4, decorin, EGFR, CD105, CD64, CD16, CD16a, CD16b, GLI1,GLI2, CD49b, and CD49f. See, for example, Schulenburg et al., 2010,PMID: 20185329, U.S. Pat. No. 7,632,678 and U.S.P.Ns. 2007/0292414,2008/0175870, 2010/0275280, 2010/0162416 and 2011/0020221 each of whichis incorporated herein by reference. It will further be appreciated thateach of the aforementioned markers may also be used as a secondarytarget antigen in the context of the bispecific or multispecificantibodies of the instant invention.

Similarly, non-limiting examples of cell surface phenotypes associatedwith cancer stem cells of certain tumor types includeCD44^(hi)CD24^(low), ALDH⁺, CD133⁺, CD123⁺, CD34⁺CD38⁻, CD44⁺CD24⁻,CD46^(hi)CD324⁺CD66c⁻, CD133⁻CD34⁺CD10⁻CD19⁻, CD138⁻CD34⁻CD19⁺,CD133⁺RC2⁺, CD44⁻α₂ β₁ ^(hi)CD133⁺, CD44⁺CD24⁺ESA⁺, CD271⁺, ABCB5⁺ aswell as other cancer stem cell surface phenotypes that are known in theart. See, for example, Schulenburg et al., 2010, supra, Visvader et al.,2008, PMID: 18784658 and U.S.P.N. 2008/0138313, each of which isincorporated herein in its entirety by reference. Those skilled in theart will appreciate that marker phenotypes such as those exemplifiedimmediately above may be used in conjunction with standard flowcytometric analysis and cell sorting techniques to characterize,isolate, purify or enrich TIC and/or TPC cells or cell populations forfurther analysis. Of interest with regard to the instant invention CD46,CD324 and, optionally, CD66c are either highly or heterogeneouslyexpressed on the surface of many human colorectal (“CR”), breast (“BR”),non-small cell lung (NSCLC), small cell lung (SCLC), pancreatic (“PA”),melanoma (“Mel”), ovarian (“OV”), and head and neck cancer (“HN”) tumorcells, regardless of whether the tumor specimens being analyzed wereprimary patient tumor specimens or patient-derived NTX tumors.

Using any of the above-referenced methods and selected markers as knownin the art it is then possible to quantify the reduction in frequency ofTIC (or the TPC therein) provided by the disclosed SEZ6 modulators(including those conjugated to cytotoxic agents) in accordance with theteachings herein. In some instances, the compounds of the instantinvention may reduce the frequency of TIC or TPC (by a variety ofmechanisms noted above, including elimination, induced differentiation,niche disruption, silencing, etc.) by 10%, 15%, 20%, 25%, 30% or even by35%. In other embodiments, the reduction in frequency of TIC or TPC maybe on the order of 40%, 45%, 50%, 55%, 60% or 65%. In certainembodiments, the disclosed compounds my reduce the frequency of TIC orTPC by 70%, 75%, 80%, 85%, 90% or even 95%. Of course it will beappreciated that any reduction of the frequency of the TIC or TPC likelyresults in a corresponding reduction in the tumorigenicity, persistence,recurrence and aggressiveness of the neoplasia.

IV. SEZ6 Modulators

In any event, the present invention is directed to the use of SEZ6modulators, including SEZ6 antagonists, for the diagnosis, theragnosis,treatment and/or prophylaxis of various disorders including any one of anumber of SEZ6 associated malignancies. The disclosed modulators may beused alone or in conjunction with a wide variety of anti-cancercompounds such as chemotherapeutic or immunotherapeutic agents (e.g.,therapeutic antibodies) or biological response modifiers. In otherselected embodiments, two or more discrete SEZ6 modulators may be usedin combination to provide enhanced anti-neoplastic effects or may beused to fabricate multispecific constructs.

In certain embodiments, the SEZ6 modulators of the present inventionwill comprise nucleotides, oligonucleotides, polynucleotides, peptidesor polypeptides. More particularly, exemplary modulators of theinvention may comprise antibodies and antigen-binding fragments orderivatives thereof, proteins, peptides, glycoproteins, glycopeptides,glycolipids, polysaccharides, oligosaccharides, nucleic acids, antisenseconstructs, siRNA, miRNA, bioorganic molecules, peptidomimetics,pharmacological agents and their metabolites, transcriptional andtranslation control sequences, and the like. In certain embodiments themodulators will comprise soluble SEZ6 (sSEZ6) or a form, variant,derivative or fragment thereof including, for example, SEZ6 fusionconstructs (e.g., SEZ6-Fc, SEZ6-targeting moiety, etc.) orSEZ6-conjugates (e.g., SEZ6-PEG, SEZ6-cytotoxic agent, SEZ6-brm, etc.).It will also be appreciated that, in other embodiments, the SEZ6modulators comprise antibodies or immunoreactive fragments orderivatives thereof. In particularly preferred embodiments themodulators of the instant invention will comprise neutralizingantibodies or derivatives or fragments thereof. In other embodiments theSEZ6 modulators may comprise internalizing antibodies or fragmentsthereof. In still other embodiments the SEZ6 modulators may comprisedepleting antibodies or fragments thereof. Moreover, as with theaforementioned fusion constructs, these antibody modulators may beconjugated, linked or otherwise associated with selected cytotoxicagents, polymers, biological response modifiers (BRMs) or the like toprovide directed immunotherapies with various (and optionally multiple)mechanisms of action. As alluded to above such antibodies may bepan-SEZ6 antibodies and associate with two or more SEZ6 family members(e.g., SEZ6 and SEZ6L as shown in FIG. 11A) or immunospecific antibodiesthat selectively react with one or both isoforms of SEZ6. In yet otherembodiments the modulators may operate on the genetic level and maycomprise compounds as antisense constructs, siRNA, miRNA and the likethat interact or associate with the genotypic component of a SEZ6determinant.

It will further be appreciated that the disclosed SEZ6 modulators maydeplete, silence, neutralize, eliminate or inhibit growth, propagationor survival of tumor cells, including TPC, and/or associated neoplasiathrough a variety of mechanisms, including agonizing or antagonizingselected pathways or eliminating specific cells depending, for example,on the form of SEZ6 modulator, any associated payload or dosing andmethod of delivery. Thus, while preferred embodiments disclosed hereinare directed to the depletion, inhibition or silencing of specific tumorcell subpopulations such as tumor perpetuating cells or to modulatorsthat interact with a specific epitope or domain, it must be emphasizedthat such embodiments are merely illustrative and not limiting in anysense. Rather, as set forth in the appended claims, the presentinvention is broadly directed to SEZ6 modulators and their use in thetreatment, management or prophylaxis of various SEZ6 associateddisorders irrespective of any particular mechanism, binding region ortarget tumor cell population.

Regardless of the form of the modulator selected it will be appreciatedthat the chosen compound may be antagonistic in nature. As used hereinan “antagonist” refers to a molecule capable of neutralizing, blocking,inhibiting, abrogating, reducing or interfering with the activities of aparticular or specified target (e.g., SEZ6), including the binding ofreceptors to ligands or the interactions of enzymes with substrates. Inthis respect it will be appreciated that SEZ6 antagonists of the instantinvention may comprise any ligand, polypeptide, peptide, fusion protein,antibody or immunologically active fragment or derivative thereof thatrecognizes, reacts, binds, combines, competes, associates or otherwiseinteracts with the SEZ6 protein or fragment thereof and eliminates,silences, reduces, inhibits, hinders, restrains or controls the growthof tumor initiating cells or other neoplastic cells including bulk tumoror NTG cell. Compatible antagonists may further include small moleculeinhibitors, aptamers, antisense constructs, siRNA, miRNA and the like,receptor or ligand molecules and derivatives thereof which recognize orassociate with a SEZ6 genotypic or phenotypic determinant therebyaltering expression patterns or sequestering its binding or interactionwith a substrate, receptor or ligand.

As used herein an antagonist refers to a molecule capable ofneutralizing, blocking, inhibiting, abrogating, reducing or interferingwith the activities of a particular or specified protein, including thebinding of receptors to ligands or the interactions of enzymes withsubstrates. More generally antagonists of the invention may compriseantibodies and antigen-binding fragments or derivatives thereof,proteins, peptides, glycoproteins, glycopeptides, glycolipids,polysaccharides, oligosaccharides, nucleic acids, antisense constructs,siRNA, miRNA, bioorganic molecules, peptidomimetics, pharmacologicalagents and their metabolites, transcriptional and translation controlsequences, and the like. Antagonists may also include small moleculeinhibitors, fusion proteins, receptor molecules and derivatives whichbind specifically to the protein thereby sequestering its binding to itssubstrate target, antagonist variants of the protein, antisensemolecules directed to the protein, RNA aptamers, and ribozymes againstthe protein.

As used herein and applied to two or more molecules or compounds, theterms “recognizes” or “associates” shall be held to mean the reaction,binding, specific binding, combination, interaction, connection,linkage, uniting, coalescence, merger or joining, covalently ornon-covalently, of the molecules whereby one molecule exerts an effecton the other molecule.

Moreover, as demonstrated in the examples herein (e.g., see FIG. 11),some modulators of human SEZ6 may, in certain cases, cross-react withSEZ6 from a species other than human (e.g., rat or cynomolgus monkey).In other cases exemplary modulators may be specific for one or moreisoforms of human SEZ6 and will not exhibit cross-reactivity with SEZ6orthologs from other species. Of course, in conjunction with theteachings herein such embodiments may comprise pan-SEZ6 antibodies thatassociate with two or more SEZ6 family members from a single species orantibodies that exclusively associate with SEZ6.

In any event, and as will be discussed in more detail below, thoseskilled in the art will appreciate that the disclosed modulators may beused in a conjugated or unconjugated form. That is, the modulator may beassociated with or conjugated to (e.g. covalently or non-covalently)pharmaceutically active compounds, biological response modifiers,anti-cancer agents, cytotoxic or cytostatic agents, diagnostic moietiesor biocompatible modifiers. In this respect it will be understood thatsuch conjugates may comprise peptides, polypeptides, proteins, fusionproteins, nucleic acid molecules, small molecules, mimetic agents,synthetic drugs, inorganic molecules, organic molecules andradioisotopes. Moreover, as indicated herein the selected conjugate maybe covalently or non-covalently linked to the SEZ6 modulator in variousmolar ratios depending, at least in part, on the method used to effectthe conjugation.

V. Modulator Fabrication and Supply

A. Antibody Modulators

1. Overview

As previously alluded to particularly preferred embodiments of theinstant invention comprise SEZ6 modulators in the form of antibodiesthat preferentially associate with one or more isoforms of SEZ6 (and,optionally, may cross-react with other SEZ6 family members). Those ofordinary skill in the art will appreciate the well developed knowledgebase on antibodies such as set forth, for example, in Abbas et al.,Cellular and Molecular Immunology, 6^(th) ed., W.B. Saunders Company(2010) or Murphey et al., Janeway's Immunobiology, 8^(th) ed., GarlandScience (2011), each of which is incorporated herein by reference in itsentirety.

The term “antibody” comprises polyclonal antibodies, multiclonalantibodies, monoclonal antibodies, chimeric antibodies, humanized andprimatized antibodies, human antibodies, recombinantly producedantibodies, intrabodies, multispecific antibodies, bispecificantibodies, monovalent antibodies, multivalent antibodies,anti-idiotypic antibodies, synthetic antibodies, including muteins andvariants thereof; antibody fragments such as Fab fragments, F(ab′)fragments, single-chain FvFcs, single-chain Fvs; and derivatives thereofincluding Fc fusions and other modifictaions, and any otherimmunologically active molecule so long as they exhibit the desiredbiological activity (i.e., antigen association or binding). Moreover,the term further comprises all classes of antibodies (i.e. IgA, IgD,IgE, IgG, and IgM) and all isotypes (i.e., IgG1, IgG2, IgG3, IgG4, IgA1,and IgA2), as well as variations thereof unless otherwise dictated bycontext. Heavy-chain constant domains that correspond to the differentclasses of antibodies are denoted by the corresponding lower case Greekletter α, δ, ε, γ, and μ, respectively. Light chains of the antibodiesfrom any vertebrate species can be assigned to one of two clearlydistinct types, called kappa (κ) and lambda (λ), based on the amino acidsequences of their constant domains.

While all such antibodies are within the scope of the present invention,preferred embodiments comprising the IgG class of immunoglobulin will bediscussed in some detail herein solely for the purposes of illustration.It will be understood that such disclosure is, however, merelydemonstrative of exemplary compositions and methods of practicing thepresent invention and not in any way limiting of the scope of theinvention or the claims appended hereto.

As is well known, the variable domains of both the light (V_(L)) andheavy (V_(H)) chain portions determine antigen recognition andspecificity and the constant domains of the light chain (C_(L)) and theheavy chain (C_(H)1, C_(H)2 or C_(H)3) confer and regulate importantbiological properties such as secretion, transplacental mobility,circulation half-life, complement binding, and the like.

The “variable” region includes hypervariable sites that manifestthemselves in three segments commonly termed complementarity determiningregions (CDRs), in both the light-chain and the heavy-chain variabledomains. The more highly conserved portions of variable domains flankingthe CDRs are termed framework regions (FRs). For example, in naturallyoccurring monomeric immunoglobulin G (IgG) antibodies, the six CDRspresent on each arm of the “Y” are short, non-contiguous sequences ofamino acids that are specifically positioned to form the antigen bindingsite as the antibody assumes its three dimensional configuration in anaqueous environment. Thus, each naturally occurring IgG antibodycomprises two identical binding sites proximal to the amino-terminus ofeach arm of the Y.

It will be appreciated that the position of CDRs can be readilyidentified by one of ordinary skill in the art using standardtechniques. Also familiar to those in the art is the numbering systemdescribed in Kabat et al. (1991, NIH Publication 91-3242, NationalTechnical Information Service, Springfield, Va.). In this regard Kabatet al. defined a numbering system for variable domain sequences that isapplicable to any antibody. One of ordinary skill in the art canunambiguously assign this system of “Kabat numbering” to any variabledomain sequence, without reliance on any experimental data beyond thesequence itself. Unless otherwise specified, references to the numberingof specific amino acid residue positions in an antibody are according tothe Kabat numbering system.

Thus, according to Kabat, in the V_(H), residues 31-35 comprise CDR1,residues 50-65 make up CDR2, and 95-102 comprise CDR3, while in theV_(L), residues 24-34 are CDR1, 50-56 comprise CDR2, and 89-97 make upCDR3. For context, in a V_(H), FR1 corresponds to the domain of thevariable region encompassing amino acids 1-30; FR2 corresponds to thedomain of the variable region encompassing amino acids 36-49; FR3corresponds to the domain of the variable region encompassing aminoacids 66-94, and FR4 corresponds to the domain of the variable regionfrom amino acids 103 to the end of the variable region. The FRs for thelight chain are similarly separated by each of the light chain variableregion CDRs.

Note that CDRs vary considerably from antibody to antibody (and bydefinition will not exhibit homology with the Kabat consensussequences). In addition, the identity of certain individual residues atany given Kabat site number may vary from antibody chain to antibodychain due to interspecies or allelic divergence. Alternative numberingis set forth in Chothia et al., J. Mol. Biol. 196:901-917 (1987) andMacCallum et al., J. Mol. Biol. 262:732-745 (1996), although as inKabat, the FR boundaries are separated by the respective CDR termini asdescribed above. See also Chothia et al., Nature 342, pp. 877-883 (1989)and S. Dubel, ed., Handbook of Therapeutic Antibodies, 3^(rd) ed.,WILEY-VCH Verlag GmbH and Co. (2007), where the definitions includeoverlapping or subsets of amino acid residues when compared against eachother. Each of the aforementioned references is incorporated herein byreference in its entirety and the amino acid residues which comprisebinding regions or CDRs as defined by each of the above cited referencesand are set forth for comparison in Table 1 below.

TABLE 1 CDR Definitions Kabat¹ Chothia² MacCallum³ V_(H) CDR1 31-3526-32 30-35 V_(H) CDR2 50-65 50-58 47-58 V_(H) CDR3  95-102  95-102 93-101 V_(L) CDR1 24-34 23-34 30-36 V_(L) CDR2 50-56 50-56 46-55 V_(L)CDR3 89-97 89-97 89-96 ¹Residue numbering follows the nomenclature ofKabat et al., supra ²Residue numbering follows the nomenclature ofChothia et al., supra ³Residue numbering follows the nomenclature ofMacCallum et al., supra

More practically variable regions and CDRs in an antibody sequence canbe identified (i) according to general rules that have been developed inthe art such as those discussed above or (ii) by aligning the sequencesagainst a database of known variable regions. Methods for identifyingthese regions are described in Kontermann and Dubel, eds., AntibodyEngineering, Springer, New York, N.Y., 2001, and Dinarello et al.,Current Protocols in Immunology, John Wiley and Sons Inc., Hoboken,N.J., 2000. Exemplary databases of antibody sequences are described in,and can be accessed through, the “Abysis” website atwww.bioinf.org.uk/abs (maintained by A. C. Martin in the Department ofBiochemistry & Molecular Biology University College London, London,England) and VBASE2 website at www.vbase2.org, as described in Retter etal., Nucl. Acids Res., 33 (Database issue): D671-D674 (2005). In thisregard the Abysis database website will automatically designate andannotate CDRs and framework regions (as per any of the commonly usednumbering systems) upon entry of the subject heavy or light chainvariable region nucleic acid or amino acid sequence. Moreover, theAbysis database website also includes general rules that have beendeveloped for readily identifying CDRs which can be used in accordancewith the teachings herein. In the context of the instant invention itwill be appreciated that any of the disclosed light and heavy chain CDRsderived from the murine variable region amino acid sequences set forthin FIG. 10A or FIG. 10B may be combined or rearranged to provideoptimized anti-SEZ6 (e.g. humanized, CDR grafted or chimeric anti-hSEZ6)antibodies in accordance with the instant teachings. That is, one ormore of the CDRs derived from the light chain variable region amino acidsequences set forth in FIG. 10A (SEQ ID NOS: 20-168, even numbers) orthe heavy chain variable region amino acid sequences set forth in FIG.10B (SEQ ID NOS: 21-169, odd numbers) may be incorporated in a SEZ6modulator and, in particularly preferred embodiments, in a CDR graftedor humanized antibody that immunospecifically associates with one ormore SEZ6 isoforms. Examples of light (SEQ ID NOS: 170-192, evennumbers) and heavy (SEQ ID NOS: 171-193, odd numbers and 194-199) chainvariable region amino acid sequences of such humanized modulators arealso set forth in FIGS. 10A and 10B.

Note that hSC17.200vL1 (SEQ ID NO: 192) is a variant of the humanizedlight chain construct hSC17.200 (SEQ ID NO: 190), hSC17.155vH1-vH6 (SEQID NOS: 193-198) are variants of the heavy chain construct hSC.155 (SEQID NO: 184) which is derived from SC17.90 (SEQ ID NO: 127) and thathSC161vH1 (SEQ ID NO: 199) is a variant of the heavy chain constructhSC17.161 (SEQ ID NO: 189). As will be discussed in more detail belowthese variants were constructed and tested to optimize one or morebiochemical properties of the parent antibody. The full length aminoacid sequences of exemplary humanized antibodies, hSC17.200 andhSC17.200vL1 are set out in FIG. 10C as SEQ ID NOs: 400-402. Thehumanized antibody variant hSC17.200vL1 is derived from humanizedantibody hSC17.200 and shares a common HC with the hSC17.200 antibody.Thus the full length LC and HC of hSC17.200 correspond to SEQ ID NOs:400 and 401, respectively; and the full length LC and HC of hSC17.200vL1correspond to SEQ ID NOs: 403 and 401, respectively.

Taken together these novel amino acid sequences depict seventy-fivemurine and eleven humanized exemplary modulators (along with reportedvariants) in accordance with the instant invention. Moreover,corresponding nucleic acid sequences of each of the seventy-fiveexemplary murine modulators and eleven humanized modulators and variantsset forth in FIGS. 10A and 10B are included in the sequence listing ofthe instant application (SEQ ID NOS: 220-399).

In FIGS. 10A and 10B the annotated CDRs are defined using Kabatnumbering. However, as discussed herein and demonstrated in Example 8below, one skilled in the art could readily define, identify, deriveand/or enumerate the CDRs as defined by Chothia et al., MacCallum et al.or one of the website databases such as Abysis or VBase2 for eachrespective heavy and light chain sequence set forth in FIG. 10A or FIG.10B. Accordingly, each of the subject CDRs and antibodies comprisingCDRs defined by all such nomenclature are expressly included within thescope of the instant invention. More broadly, the terms “variable regionCDR amino acid residue” or more simply “CDR” includes amino acids in aCDR as identified using any sequence or structure based method as setforth above.

For any heavy chain constant region amino acid positions discussed inthe present application, numbering is according to the Eu index firstdescribed in Edelman et al., 1969, Proc, Natl. Acad. Sci. USA 63(1):78-85 describing the amino acid sequence of myeloma protein Eu, whichreportedly was the first human IgG1 sequenced. The Eu index of Edelmanis also set forth in Kabat et al., 1991 (supra.). Thus, the terms “EUindex as set forth in Kabat” or “EU index of Kabat” in the context ofthe heavy chain refers to the residue numbering system based on thehuman IgG1 Eu antibody of Edelman et al. as set forth in Kabat et al.,1991 (supra.). The numbering system used for the light chain constantregion amino acid sequence is similarly set forth in Kabat 1991.Exemplary kappa C_(L) and IgG1 heavy chain constant region amino acidsequences compatible with the instant invention are set forth as SEQ IDNOS: 403 and 404 in the appended sequence listing. Those of skill in theart will appreciate that the disclosed constant region sequences may bejoined with the disclosed heavy and light chain variable regions usingstandard molecular biology techniques to provide full-length antibodiesthat may be incorporated in the SEZ6 antibodies and ADCs of the instantinvention.

As set forth below in the Examples, selected embodiments of theinvention comprise murine antibodies that immunospecifically bind toSEZ6, which can be considered “source” antibodies or “reference”antibodies. In other embodiments, antibodies contemplated by theinvention may be derived from such “source” or “reference” antibodiesthrough optional modification of the constant region or theepitope-binding amino acid sequences of the source antibody. In oneembodiment an antibody is “derived” from a source antibody if selectedamino acids in the source antibody are altered through deletion,mutation, substitution, integration or combination. In anotherembodiment, a “derived” antibody is one in which fragments of the sourceantibody (e.g., one or more CDRs or the entire variable region) arecombined with or incorporated into an acceptor antibody sequence toprovide the derivative antibody (e.g. chimeric, CDR grafted or humanizedantibodies). These “derived” (e.g. humanized or CDR-grafted) antibodiescan be generated using standard molecular biology techniques for variousreasons such as, for example, to improve affinity for the determinant;to improve production and yield in cell culture; to reduceimmunogenicity in vivo; to reduce toxicity; to facilitate conjugation ofan active moiety; or to create a multispecific antibody. Such antibodiesmay also be derived from source antibodies through modification of themature molecule (e.g., glycosylation patterns or pegylation) by chemicalmeans or post-translational modification. Examples of “source” murineantibodies of the invention are SC17.155, SC17.161 and SC17.200 andexamples of antibodies that are derived from such source antibodies arehSC17.155, hSC17.155vH1-vH5 (derived from SC17.155); hSC17.161vL1(derived from SC17.161) and hSC17.200vL1 (derived from hSC17.200).

2. Antibody Modulator Generation

a. Polyclonal Antibodies

The production of polyclonal antibodies in various host animals,including rabbits, mice, rats, etc. is well known in the art. In someembodiments, polyclonal anti-SEZ6 antibody-containing serum is obtainedby bleeding or sacrificing the animal. The serum may be used forresearch purposes in the form obtained from the animal or, in thealternative, the anti-SEZ6 antibodies may be partially or fully purifiedto provide immunoglobulin fractions or homogeneous antibodypreparations.

Briefly the selected animal is immunized with a SEZ6 immunogen (e.g.,soluble SEZ6 or sSEZ6) which may, for example, comprise selectedisoforms, domains and/or peptides, or live cells or cell preparationsexpressing SEZ6 or immunoreactive fragments thereof. Art known adjuvantsthat may be used to increase the immunological response, depending onthe inoculated species include, but are not limited to, Freund's(complete and incomplete), mineral gels such as aluminum hydroxide,surface active substances such as lysolecithin, pluronic polyols,polyanions, peptides, oil emulsions, keyhole limpet hemocyanins,dinitrophenol, and potentially useful human adjuvants such as BCG(bacille Calmette-Guerin) and corynebacterium parvum. Such adjuvants mayprotect the antigen from rapid dispersal by sequestering it in a localdeposit, or they may contain substances that stimulate the host tosecrete factors that are chemotactic for macrophages and othercomponents of the immune system. Preferably the immunization schedulewill involve two or more administrations of the selected immunogenspread out over a predetermined period of time.

The amino acid sequence of a SEZ6 protein as shown in FIGS. 1C or 1D canbe analyzed to select specific regions of the SEZ6 protein forgenerating antibodies. For example, hydrophobicity and hydrophilicityanalyses of a SEZ6 amino acid sequence are used to identify hydrophilicregions in the SEZ6 structure. Regions of a SEZ6 protein that showimmunogenic structure, as well as other regions and domains, can readilybe identified using various other methods known in the art, such asChou-Fasman, Garnier-Robson, Kyte-Doolittle, Eisenberg, Karplus-Schultzor Jameson-Wolf analysis. Average Flexibility profiles can be generatedusing the method of Bhaskaran R., Ponnuswamy P. K., 1988, Int. J. Pept.Protein Res. 32:242-255. Beta-turn profiles can be generated using themethod of Deleage, G., Roux B., 1987, Protein Engineering 1:289-294.Thus, each SEZ6 region, domain or motif identified by any of theseprograms or methods is within the scope of the present invention and maybe isolated or engineered to provide immunogens giving rise tomodulators comprising desired properties. Preferred methods for thegeneration of SEZ6 antibodies are further illustrated by way of theExamples provided herein. Methods for preparing a protein or polypeptidefor use as an immunogen are well known in the art. Also well known inthe art are methods for preparing immunogenic conjugates of a proteinwith a carrier, such as BSA, KLH or other carrier protein. In somecircumstances, direct conjugation using, for example, carbodiimidereagents are used; in other instances linking reagents are effective.Administration of a SEZ6 immunogen is often conducted by injection overa suitable time period and with use of a suitable adjuvant, as isunderstood in the art. During the immunization schedule, titers ofantibodies can be taken as described in the Examples below to determineadequacy of antibody formation.

b. Monoclonal Antibodies

In addition, the invention contemplates use of monoclonal antibodies. Asknown in the art, the term “monoclonal antibody” (or mAb) refers to anantibody obtained from a population of substantially homogeneousantibodies, i.e., the individual antibodies comprising the populationare identical except for possible mutations (e.g., naturally occurringmutations), that may be present in minor amounts. In certainembodiments, such a monoclonal antibody includes an antibody comprisinga polypeptide sequence that binds or associates with an antigen whereinthe antigen-binding polypeptide sequence was obtained by a process thatincludes the selection of a single target binding polypeptide sequencefrom a plurality of polypeptide sequences.

More generally, and as exemplified in Example 6 herein, monoclonalantibodies can be prepared using a wide variety of techniques known inthe art including hybridoma, recombinant techniques, phage displaytechnologies, transgenic animals (e.g., a XenoMouse®) or somecombination thereof. For example, monoclonal antibodies can be producedusing hybridoma and art-recognized biochemical and genetic engineeringtechniques such as described in more detail in An, Zhigiang (ed.)Therapeutic Monoclonal Antibodies: From Bench to Clinic, John Wiley andSons, 1^(st) ed. 2009; Shire et. al. (eds.) Current Trends in MonoclonalAntibody Development and Manufacturing, Springer Science+Business MediaLLC, 1^(st) ed. 2010; Harlow et al., Antibodies: A Laboratory Manual,Cold Spring Harbor Laboratory Press, 2nd ed. 1988; Hammerling, et al.,in: Monoclonal Antibodies and T-Cell Hybridomas 563-681 (Elsevier, N.Y.,1981) each of which is incorporated herein in its entirety by reference.It should be understood that a selected binding sequence can be furtheraltered, for example, to improve affinity for the target, to humanizethe target binding sequence, to improve its production in cell culture,to reduce its immunogenicity in vivo, to create a multispecificantibody, etc., and that an antibody comprising the altered targetbinding sequence is also an antibody of this invention.

c. Chimeric Antibodies

In another embodiment, the antibody of the invention may comprisechimeric antibodies derived from covalently joined protein segments fromat least two different species or types of antibodies. As known in theart, the term “chimeric” antibodies is directed to constructs in which aportion of the heavy and/or light chain is identical with or homologousto corresponding sequences in antibodies derived from a particularspecies or belonging to a particular antibody class or subclass, whilethe remainder of the chain(s) is identical with or homologous tocorresponding sequences in antibodies derived from another species orbelonging to another antibody class or subclass, as well as fragments ofsuch antibodies, so long as they exhibit the desired biological activity(U.S. Pat. No. 4,816,567; Morrison et al., Proc. Natl. Acad. Sci. USA,81:6851-6855 (1984)).

In one embodiment, a chimeric antibody in accordance with the teachingsherein may comprise murine V_(H) and V_(L) amino acid sequences andconstant regions derived from human sources. In other compatibleembodiments a chimeric antibody of the present invention may comprise ahumanized antibody as described below. In another embodiment, theso-called “CDR-grafted” antibody, the antibody comprises one or moreCDRs from a particular species or belonging to a particular antibodyclass or subclass, while the remainder of the antibody chain(s) is/areidentical with or homologous to a corresponding sequence in antibodiesderived from another species or belonging to another antibody class orsubclass. For use in humans, selected rodent CDRs may be grafted into ahuman antibody, replacing one or more of the naturally occurringvariable regions or CDRs of the human antibody. These constructsgenerally have the advantages of providing full strength modulatorfunctions (e.g., CDC (complement dependent cytotoxicity), ADCC(antibody-dependent cell-mediated cytotoxicity), etc.) while reducingunwanted immune responses to the antibody by the subject.

d. Humanized Antibodies

Similar to the CDR-grafted antibody is a “humanized” antibody. As usedherein, “humanized” forms of non-human (e.g., murine) antibodies arechimeric antibodies that contain a minimal sequence derived from one ormore non-human immunoglobulins. In one embodiment, a humanized antibodyis a human immunoglobulin (recipient or acceptor antibody) in whichresidues from a CDR of the recipient are replaced by residues from a CDRof a non-human species (donor antibody) such as mouse, rat, rabbit, ornonhuman primate having the desired specificity, affinity, and/orcapacity. In certain preferred embodiments, residues in one or more FRsin the variable domain of the human immunoglobulin are replaced bycorresponding non-human residues from the donor antibody to helpmaintain the appropriate three-dimensional configuration of the graftedCDR(s) and thereby improve affinity. Furthermore, humanized antibodiesmay comprise residues that are not found in the recipient antibody or inthe donor antibody to, for example, further refine antibody performance.

CDR grafting and humanized antibodies are described, for example, inU.S. Pat. Nos. 6,180,370 and 5,693,762. The humanized antibodyoptionally may also comprise at least a portion of an immunoglobulin Fc,typically that of a human immunoglobulin. For further details, see,e.g., Jones et al., Nature 321:522-525 (1986); and U.S. Pat. Nos.6,982,321 and 7,087,409. Still another method is termed “humaneering”which is described, for example, in U.S.P.N. 2005/0008625. Additionally,a non-human antibody may also be modified by specific deletion of humanT-cell epitopes or “deimmunization” by the methods disclosed in WO98/52976 and WO 00/34317. Each of the aforementioned references areincorporated herein in their entirety.

Humanized antibodies may also be bioengineered using common molecularbiology techniques, such as isolating, manipulating, and expressingnucleic acid sequences that encode all or part of immunoglobulinvariable regions from at least one of a heavy or light chain. Inaddition to the sources of such nucleic acid noted above, human germlinesequences are available as disclosed, for example, in Tomlinson, I. A.et al. (1992) J. Mol. Biol. 227:776-798; Cook, G. P. et al. (1995)Immunol. Today 16: 237-242; Chothia, D. et al. (1992) J. Mol. Biol.227:799-817; and Tomlinson et al. (1995) EMBO J 14:4628-4638. The V-BASEdirectory (VBASE2—Retter et al., Nucleic Acid Res. 33; 671-674, 2005)provides a comprehensive directory of human immunoglobulin variableregion sequences (compiled by Tomlinson, I. A. et al. MRC Centre forProtein Engineering, Cambridge, UK). Consensus human FRs can also beused, e.g., as described in U.S. Pat. No. 6,300,064.

In selected embodiments, and as detailed in Example 8 below, at least60%, 65%, 70%, 75%, or 80% of the humanized antibody heavy or lightchain variable region amino acid residues will correspond to those ofthe recipient FR and CDR sequences. In other embodiments at least 85% or90% of the humanized antibody variable region residues will correspondto those of the recipient FR and CDR sequences. In a further preferredembodiment, greater than 95% of the humanized antibody variable regionresidues will correspond to those of the recipient FR and CDR sequences.

e. Human Antibodies

In another embodiment, the antibodies may comprise fully humanantibodies. The term “human antibody” refers to an antibody whichpossesses an amino acid sequence that corresponds to that of an antibodyproduced by a human and/or has been made using any of the techniques formaking human antibodies.

Human antibodies can be produced using various techniques known in theart. One technique is phage display in which a library of (preferablyhuman) antibodies is synthesized on phages, the library is screened withthe antigen of interest or an antibody-binding portion thereof, and thephage that binds the antigen is isolated, from which one may obtain theimmunoreactive fragments. Methods for preparing and screening suchlibraries are well known in the art and kits for generating phagedisplay libraries are commercially available (e.g., the PharmaciaRecombinant Phage Antibody System, catalog no. 27-9400-01; and theStratagene SurfZAP™ phage display kit, catalog no. 240612). There alsoare other methods and reagents that can be used in generating andscreening antibody display libraries (see, e.g., U.S. Pat. No.5,223,409; PCT Publication Nos. WO 92/18619, WO 91/17271, WO 92/20791,WO 92/15679, WO 93/01288, WO 92/01047, WO 92/09690; and Barbas et al.,Proc. Natl. Acad. Sci. USA 88:7978-7982 (1991)).

In one embodiment, recombinant human antibodies may be isolated byscreening a recombinant combinatorial antibody library prepared asabove. In one embodiment, the library is a scFv phage display library,generated using human V_(L) and V_(H) cDNAs prepared from mRNA isolatedfrom B-cells.

The antibodies produced by naive libraries (either natural or synthetic)can be of moderate affinity (K_(a) of about 10⁶ to 10⁷ M⁻¹), butaffinity maturation can also be mimicked in vitro by constructing andreselecting from secondary libraries as described in the art. Forexample, mutation can be introduced at random in vitro by usingerror-prone polymerase (reported in Leung et al., Technique, 1: 11-15(1989)). Additionally, affinity maturation can be performed by randomlymutating one or more CDRs, e.g. using PCR with primers carrying randomsequence spanning the CDR of interest, in selected individual Fv clonesand screening for higher-affinity clones. WO 9607754 described a methodfor inducing mutagenesis in a CDR of an immunoglobulin light chain tocreate a library of light chain genes. Another effective approach is torecombine the V_(H) or V_(L) domains selected by phage display withrepertoires of naturally occurring V domain variants obtained fromunimmunized donors and to screen for higher affinity in several roundsof chain reshuffling as described in Marks et al., Biotechnol., 10:779-783 (1992). This technique allows the production of antibodies andantibody fragments with a dissociation constant K_(D) (k_(off)/k_(on))of about 10⁻⁹ M or less.

In other embodiments, similar procedures may be employed using librariescomprising eukaryotic cells (e.g., yeast) that express binding pairs ontheir surface. See, for example, U.S. Pat. No. 7,700,302 and U.S. Ser.No. 12/404,059. In one embodiment, the human antibody is selected from aphage library, where that phage library expresses human antibodies(Vaughan et al. Nature Biotechnology 14:309-314 (1996): Sheets et al.Proc. Natl. Acad. Sci. USA 95:6157-6162 (1998). In other embodiments,human binding pairs may be isolated from combinatorial antibodylibraries generated in eukaryotic cells such as yeast. See e.g., U.S.Pat. No. 7,700,302. Such techniques advantageously allow for thescreening of large numbers of candidate modulators and provide forrelatively easy manipulation of candidate sequences (e.g., by affinitymaturation or recombinant shuffling).

Human antibodies can also be made by introducing human immunoglobulinloci into transgenic animals, e.g., mice in which the endogenousimmunoglobulin genes have been partially or completely inactivated andhuman immunoglobulin genes have been introduced. Upon challenge, humanantibody production is observed, which closely resembles that seen inhumans in all respects, including gene rearrangement, assembly, andantibody repertoire. This approach is described, for example, in U.S.Pat. Nos. 5,545,807; 5,545,806; 5,569,825; 5,625,126; 5,633,425;5,661,016, and U.S. Pat. Nos. 6,075,181 and 6,150,584 regardingXenoMouse® technology; and Lonberg and Huszar, Intern. Rev. Immunol.13:65-93 (1995). Alternatively, the human antibody may be prepared viaimmortalization of human B lymphocytes producing an antibody directedagainst a target antigen (such B lymphocytes may be recovered from anindividual suffering from a neoplastic disorder or may have beenimmunized in vitro). See, e.g., Cole et al., Monoclonal Antibodies andCancer Therapy, Alan R. Liss, p. 77 (1985); Boerner et al., J. Immunol,147 (1):86-95 (1991); and U.S. Pat. No. 5,750,373.

3. Further Processing

No matter how obtained, modulator-producing cells (e.g., hybridomas,yeast colonies, etc.) may be selected, cloned and further screened fordesirable characteristics including, for example, robust growth, highantibody production and, as discussed in more detail below, desirableantibody characteristics. Hybridomas can be expanded in vivo insyngeneic animals, in animals that lack an immune system, e.g., nudemice, or in cell culture in vitro. Methods of selecting, cloning andexpanding hybridomas and/or colonies, each of which produces a discreteantibody species, are well known to those of ordinary skill in the art.

B. Recombinant Modulator Production

1. Overview

Once the source is perfected DNA encoding the desired SEZ6 modulatorsmay be readily isolated and sequenced using conventional procedures(e.g., by using oligonucleotide probes that are capable of bindingspecifically to genes encoding antibody heavy and light chains).Isolated and subcloned hybridoma cells (or phage or yeast derivedcolonies) may serve as a preferred source of such DNA if the modulatoris an antibody. If desired, the nucleic acid can further be manipulatedas described herein to create agents including fusion proteins, orchimeric, humanized or fully human antibodies. More particularly,isolated DNA (which may be modified) can be used to clone constant andvariable region sequences for the manufacture antibodies.

Accordingly, in exemplary embodiments antibodies may be producedrecombinantly, using conventional procedures (such as those set forth inAl-Rubeai; An, and Shire et. al. all supra, and Sambrook J. & Russell D.Molecular Cloning: A Laboratory Manual, 3rd ed., Cold Spring HarborLaboratory Press, Cold Spring Harbor, N.Y. (2000); Ausubel et al., ShortProtocols in Molecular Biology: A Compendium of Methods from CurrentProtocols in Molecular Biology, Wiley, John & Sons, Inc. (2002)) inwhich the isolated and subcloned hybridoma cells (or phage or yeastderived colonies) serve as a preferred source of nucleic acid molecules.

The term “nucleic acid molecule”, as used herein, is intended to includeDNA molecules and RNA molecules and artificial variants thereof (e.g.,peptide nucleic acids), whether single-stranded or double-stranded. Thenucleic acids may encode one or both chains of an antibody of theinvention, or a fragment or derivative thereof. The nucleic acidmolecules of the invention also include polynucleotides sufficient foruse as hybridization probes, PCR primers or sequencing primers foridentifying, analyzing, mutating or amplifying a polynucleotide encodinga polypeptide; anti-sense nucleic acids for inhibiting expression of apolynucleotide, and as well as complementary sequences. The nucleicacids can be any length. They can be, for example, 5, 10, 15, 20, 25,30, 35, 40, 45, 50, 75, 100, 125, 150, 175, 200, 250, 300, 350, 400,450, 500, 750, 1,000, 1,500, 3,000, 5,000 or more nucleotides in length,and/or can comprise one or more additional sequences, for example,regulatory sequences, and/or be part of a larger nucleic acid, forexample, a vector. It will be appreciated that such nucleic acidsequences can further be manipulated to create modulators includingchimeric, humanized or fully human antibodies. More particularly,isolated nucleic acid molecules (which may be modified) can be used toclone constant and variable region sequences for the manufactureantibodies as described in U.S. Pat. No. 7,709,611.

The term “isolated nucleic acid” means a that the nucleic acid was (i)amplified in vitro, for example by polymerase chain reaction (PCR), (ii)recombinantly produced by cloning, (iii) purified, for example bycleavage and gel-electrophoretic fractionation, or (iv) synthesized, forexample by chemical synthesis. An isolated nucleic acid is a nucleicacid that is available for manipulation by recombinant DNA techniques.

Whether the source of the nucleic acid encoding the desiredimmunoreactive portion of the antibody is obtained or derived from phagedisplay technology, yeast libraries, hybridoma-based technology orsynthetically, it is to be understood that the present inventionencompasses the nucleic acid molecules and sequences encoding theantibodies or antigen-binding fragments or derivatives thereof. Further,the instant invention is directed to vectors and host cells comprisingsuch nucleic acid molecules.

Once DNA fragments encoding V_(H) and V_(L) segments are obtained, theseDNA fragments can be further manipulated by standard recombinant DNAtechniques, for example to convert the variable region genes tofull-length antibody chain genes, to Fab fragment genes or to a scFvgene. In these manipulations, a V_(L)- or V_(H)-encoding DNA fragment isoperatively linked to another DNA fragment encoding another protein,such as an antibody constant region or a flexible linker. The term“operatively linked”, as used in this context, means that the two DNAfragments are joined such that the amino acid sequences encoded by thetwo DNA fragments remain in-frame.

The isolated DNA encoding the V_(H) region can be converted to afull-length heavy chain gene by operatively linking the V_(H)-encodingDNA to another DNA molecule encoding heavy chain constant regions(C_(H)1, C_(H)2 and C_(H)3). The sequences of human heavy chain constantregion genes are known in the art (see e.g., Kabat, E. A., et al. (1991)Sequences of Proteins of Immunological Interest, Fifth Edition, U.S.Department of Health and Human Services, NIH Publication No. 91-3242)and DNA fragments encompassing these regions can be obtained by standardPCR amplification. The heavy chain constant region can be an IgG1, IgG2,IgG3, IgG4, IgA, IgE, IgM or IgD constant region, but most preferably isan IgG1 or IgG4 constant region. As discussed in more detail below anexemplary IgG1 constant region that is compatible with the teachingsherein is set forth as SEQ ID NO: 403 in the appended sequence listing.For a Fab fragment heavy chain gene, the VH-encoding DNA can beoperatively linked to another DNA molecule encoding only the heavy chainCH1 constant region.

The isolated DNA encoding the V_(L) region can be converted to afull-length light chain gene (as well as a Fab light chain gene) byoperatively linking the V_(L)-encoding DNA to another DNA moleculeencoding the light chain constant region, C_(L). The sequences of humanlight chain constant region genes are known in the art (see e.g., Kabat,E. A., et al. (1991) Sequences of Proteins of Immunological Interest,Fifth Edition, U.S. Department of Health and Human Services, NIHPublication No. 91-3242) and DNA fragments encompassing these regionscan be obtained by standard PCR amplification. The light chain constantregion can be a kappa or lambda constant region, but most preferably isa kappa constant region. In this respect an exemplary compatible kappalight chain constant region is set forth as SEQ ID NO: 404 in theappended sequence listing.

2. Hybridization and Sequence Identity

As indicated, the invention further provides nucleic acids thathybridize to other nucleic acids under particular hybridizationconditions. More specifically the invention encompasses nucleic acidsmolecules that hybridize under moderate or high stringency hybridizationconditions (e.g., as defined below), to the nucleic acid molecules ofthe invention. Methods for hybridizing nucleic acids are well-known inthe art. As is well known, a moderately stringent hybridizationconditions comprise a prewashing solution containing 5×sodiumchloride/sodium citrate (SSC), 0.5% SDS, 1.0 mM EDTA (pH 8.0),hybridization buffer of about 50% formamide, 6×SSC, and a hybridizationtemperature of 55° C. (or other similar hybridization solutions, such asone containing about 50% formamide, with a hybridization temperature of42° C.), and washing conditions of 60° C., in 0.5×SSC, 0.1% SDS. By wayof comparison hybridization under highly stringent hybridizationconditions comprise washing with 6×SSC at 45° C., followed by one ormore washes in 0.1×SSC, 0.2% SDS at 68° C. Furthermore, one of skill inthe art can manipulate the hybridization and/or washing conditions toincrease or decrease the stringency of hybridization such that nucleicacids comprising nucleotide sequences that are at least 65%, 70%, 75%,80%, 85%, 90%, 95%, 98% or 99% identical to each other typically remainhybridized to each other.

The invention also includes nucleic acid molecules that are“substantially identical” to the described nucleic acid molecules. Inone embodiment, the term substantially identical with regard to anucleic acid sequence means may be construed as a sequence of nucleicacid molecules exhibiting at least about 65%, 70%, 75%, 80%, 85%, or 90%sequence identity. In other embodiments, the nucleic acid moleculesexhibit 95% or 98% sequence identity to the reference nucleic acidsequence.

The basic parameters affecting the choice of hybridization conditionsand guidance for devising suitable conditions are set forth by, forexample, Sambrook, Fritsch, and Maniatis (1989, Molecular Cloning: ALaboratory Manual, Cold Spring Harbor Laboratory Press, Cold SpringHarbor, N.Y., chapters 9 and 11; and Current Protocols in MolecularBiology, 1995, Ausubel et al., eds., John Wiley & Sons, Inc., sections2.10 and 6.3-6.4), and can be readily determined by those havingordinary skill in the art based on, for example, the length and/or basecomposition of the nucleic acid.

Sequence similarity for polypeptides, which is also referred to assequence identity, is typically measured using sequence analysissoftware. Protein analysis software matches similar sequences usingmeasures of similarity assigned to various substitutions, deletions andother modifications, including conservative amino acid substitutions.For instance, the sequence analysis tool GCG (Accelrys Software Inc.)contains programs such as “GAP” and “BEST-FIT” which can be used withdefault parameters to determine sequence homology or sequence identitybetween closely related polypeptides, such as homologous polypeptidesfrom different species of organisms or between a wild type protein and amutein thereof. (See, e.g., GCG Version 6.1 or Durbin et. Al.,Biological Sequence Analysis: Probabilistic models of proteins andnucleic acids., Cambridge Press (1998)).

Polypeptide sequences can also be compared using FASTA using default orrecommended parameters, a program in GCG Version 6.1. FASTA (e.g.,FASTA2 and

FASTA3) provides alignments and percent sequence identity of the regionsof the best overlap between the query and search sequences (Pearson(2000) supra). Another preferred algorithm when comparing a sequence ofthe invention to a database containing a large number of sequences fromdifferent organisms is the computer program BLAST, especially blastp ortblastn, using default parameters. See, e.g., Altschul et al. (1990) J.Mol. Biol. 215: 403 410 and Altschul et al. (1997) Nucleic Acids Res.25:3389 402, each of which is herein incorporated by reference.

In this regard the invention also includes nucleic acid molecules thatencode polypeptides that are “substantially identical” with respect toan antibody variable region polypeptide sequence (e.g., either the donorlight or heavy chain variable region, acceptor light or heavy chainvariable region or resulting humanized construct). As applied to suchpolypeptides, the term “substantial identity” or “substantiallyidentical” means that two peptide sequences, when optimally aligned,such as by the programs GAP or BEST-FIT using default gap weights, shareat least 60% or 65% sequence identity, preferably at least 70%, 75%,80%, 85%, or 90% sequence identity, even more preferably at least 93%,95%, 98% or 99% sequence identity. Preferably, residue positions whichare not identical differ by conservative amino acid substitutions. A“conservative amino acid substitution” is one in which an amino acidresidue is substituted by another amino acid residue having a side chain(R group) with similar chemical properties (e.g., charge orhydrophobicity). In general, a conservative amino acid substitution willnot substantially change the functional properties of a protein. Incases where two or more amino acid sequences differ from each other byconservative substitutions, the percent sequence identity or degree ofsimilarity may be adjusted upwards to correct for the conservativenature of the substitution.

3. Expression

The varied processes of recombinant expression, i.e., the production ofRNA or of RNA and protein/peptide, are well known as set forth, forexample, in Berger and Kimmel, Guide to Molecular Cloning Techniques,Methods in Enzymology volume 152 Academic Press, Inc., San Diego, Calif;Sambrook et al., Molecular Cloning-A Laboratory Manual (3rd Ed.), Vol.1-3, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y., (2000);and Current Protocols in Molecular Biology, F. M. Ausubel et al., eds.,Current Protocols, a joint venture between Greene Publishing Associates,Inc. and John Wiley & Sons, Inc., (supplemented through 2006).

Certain terms of interest include “expression control sequence” whichcomprises promoters, ribosome binding sites, enhancers and other controlelements which regulate transcription of a gene or translation of mRNA.As is well known, a “promoter” or “promoter region” relates to a nucleicacid sequence which generally is located upstream (5′) to the nucleicacid sequence being expressed and controls expression of the sequence byproviding a recognition and binding site for RNA-polymerase.

Exemplary promoters which are compatible according to the inventioninclude promoters for SP6, T3 and T7 polymerase, human U6 RNA promoter,CMV promoter, and artificial hybrid promoters thereof (e.g. CMV) where apart or parts are fused to a part or parts of promoters of genes ofother cellular proteins such as e.g. human GAPDH(glyceraldehyde-3-phosphate dehydrogenase), and including or notincluding (an) additional intron(s).

In certain embodiments, the nucleic acid molecule may be present in avector, where appropriate with a promoter, which controls expression ofthe nucleic acid. The well known term “vector” comprises anyintermediary vehicle for a nucleic acid which enables said nucleic acid,for example, to be introduced into prokaryotic and/or eukaryotic cellsand, where appropriate, to be integrated into a genome. Methods oftransforming mammalian cells are well known in the art. See, forexample, U.S. Pat. Nos. 4,399,216, 4,912,040, 4,740,461, and 4,959,455.The vectors may include a nucleotide sequence encoding an antibody ofthe invention (e.g., a whole antibody, a heavy or light chain of anantibody, a V_(H) or V_(L) of an antibody, or a portion thereof, or aheavy- or light-chain CDR, a single chain Fv, or fragments or variantsthereof), operably linked to a promoter (see, e.g., PCT Publication WO86/05807; PCT Publication WO 89/01036; and U.S. Pat. No. 5,122,464).

A variety of host-expression vector systems are commercially available,and many are compatible with the teachings herein and may be used toexpress the modulators of the invention. Such systems include, but arenot limited to, microorganisms such as bacteria (e.g., E. coli, B.subtilis, streptomyces) transformed with recombinant bacteriophage DNA,plasmid DNA or cosmid DNA expression vectors containing modulator codingsequences; yeast (e.g., Saccharomyces, Pichia) transfected withrecombinant yeast expression vectors containing modulator codingsequences; insect cell systems infected with recombinant virusexpression vectors (e.g., baculovirus) containing modulator codingsequences; plant cell systems (e.g., Nicotiana, Arabidopsis, duckweed,corn, wheat, potato, etc.) infected with recombinant viral expressionvectors (e.g., cauliflower mosaic virus; tobacco mosaic virus) ortransfected with recombinant plasmid expression vectors (e.g., Tiplasmid) containing modulator coding sequences; or mammalian cellsystems (e.g., COS, CHO, BHK, 293, 3T3 cells, etc.) harboringrecombinant expression constructs containing promoters derived from thegenome of mammalian cells (e.g., metallothionein promoter) or frommammalian viruses (e.g., the adenovirus late promoter; the vacciniavirus 7.5K promoter).

As used herein, the term “host cell” covers any kind of cellular systemwhich can be engineered to generate the polypeptides and antigen-bindingmolecules of the present invention. In one embodiment, the host cell isengineered to allow the production of an antigen binding molecule withmodified glycoforms. In a preferred embodiment, the antigen bindingmolecule, or variant antigen binding molecule, is an antibody, antibodyfragment, or fusion protein. In certain embodiments, the host cells havebeen further manipulated to express increased levels of one or morepolypeptides having N-acetylglucosaminyltransferase III (GnTI11)activity. Compatible host cells include cultured cells, e.g., mammaliancultured cells, such as CHO cells, BHK cells, NSO cells, SP2/0 cells, YOmyeloma cells, P3X63 mouse myeloma cells, PER cells, PER.C6 cells orhybridoma cells, yeast cells, insect cells, and plant cells, to nameonly a few, but also cells comprised within a transgenic animal,transgenic plant or cultured plant or animal tissue.

For long-term, high-yield production of recombinant proteins stableexpression is preferred. Accordingly, cell lines that stably express theselected modulator may be engineered using standard art-recognizedtechniques. Rather than using expression vectors that contain viralorigins of replication, host cells can be transformed with DNAcontrolled by appropriate expression control elements (e.g., promoter,enhancer, sequences, transcription terminators, polyadenylation sites,etc.), and a selectable marker. Any of the selection systems well knownin the art may be used, including the glutamine synthetase geneexpression system (the GS system) which provides an efficient approachfor enhancing expression under certain conditions. The GS system isdiscussed in whole or part in connection with EP patents 0 216 846, 0256 055, 0 323 997 and 0 338 841 and U.S. Pat. Nos. 5,591,639 and5,879,936 each of which is incorporated herein by reference. Anotherpreferred expression system, the Freedom™ CHO-S Kit is commerciallyprovided by Life Technologies (Catalog Number A13696-01) also allows forthe development of stable cell lines that may be used for modulatorproduction.

Such host-expression systems represent vehicles by which the codingsequences of interest may be produced and subsequently purified, butalso represent cells which may, when transformed or transfected with theappropriate nucleotide coding sequences, express a molecule of theinvention in situ. The host cell may be co-transfected with twoexpression vectors of the invention, for example, the first vectorencoding a heavy chain derived polypeptide and the second vectorencoding a light chain derived polypeptide.

Thus, in certain embodiments, the present invention provides recombinanthost cells allowing for the expression of antibodies or portionsthereof. Antibodies produced by expression in such recombinant hostcells are referred to herein as recombinant antibodies. The presentinvention also provides progeny cells of such host cells, and antibodiesproduced by the same.

C. Chemical Synthesis

In addition, the modulators may be chemically synthesized usingtechniques known in the art (e.g., see Creighton, 1983, Proteins:Structures and Molecular Principles, W.H. Freeman & Co., N.Y., andHunkapiller, M., et al., 1984, Nature 310:105-111). Furthermore, ifdesired, nonclassical amino acids or chemical amino acid analogs (suchas D-isomers of the common amino acids, 2,4-diaminobutyric acid, a-aminoisobutyric acid, 4-aminobutyric acid, and the like) can be introduced asa substitution or addition into a polypeptide sequence.

D. Transgenic Systems

In other embodiments modulators may be produced transgenically throughthe generation of a mammal or plant that is transgenic for recombinantmolecules such as the immunoglobulin heavy and light chain sequences andthat produces the desired compounds in a recoverable form. Thisincludes, for example, the production of protein modulators (e.g.,antibodies) in, and recovery from, the milk of goats, cows, or othermammals. See, e.g., U.S. Pat. Nos. 5,827,690, 5,756,687, 5,750,172, and5,741,957. In some embodiments, non-human transgenic animals thatcomprise human immunoglobulin loci are immunized to produce antibodies.

Other transgenic techniques are set forth in Hogan et al., Manipulatingthe Mouse Embryo: A Laboratory Manual 2nd ed., Cold Spring Harbor Press(1999); Jackson et al., Mouse Genetics and Transgenics: A PracticalApproach, Oxford University Press (2000); and Pinkert, Transgenic AnimalTechnology: A Laboratory Handbook, Academic Press (1999) and U.S. Pat.No. 6,417,429. In some embodiments, the non-human animals are mice,rats, sheep, pigs, goats, cattle or horses, and the desired product isproduced in blood, milk, urine, saliva, tears, mucus and other bodilyfluids from which it is readily obtainable using art-recognizedpurification techniques.

Other compatible production systems include methods for makingantibodies in plants such as described, for example, in U.S. Pat. Nos.6,046,037 and 5,959,177 which are incorporated herein with respect tosuch techniques.

E. Isolation/Purification

Once a modulator of the invention has been produced by recombinantexpression or any other of the disclosed techniques, it may be purifiedby any method known in the art for purification of immunoglobulins orproteins. In this respect the modulator may be “isolated” which meansthat it has been identified and separated and/or recovered from acomponent of its natural environment. Contaminant components of itsnatural environment are materials that would interfere with diagnosticor therapeutic uses for the polypeptide and may include enzymes,hormones, and other proteinaceous or nonproteinaceous solutes. Isolatedmodulators include a modulator in situ within recombinant cells becauseat least one component of the polypeptide's natural environment will notbe present.

If the desired molecule is produced intracellularly, as a first step,the particulate debris, either host cells or lysed fragments, may beremoved, for example, by centrifugation or ultrafiltration. Where themodulator is secreted into the medium, supernatants from such expressionsystems are generally first concentrated using a commercially availableprotein concentration filter, for example, an Amicon or Pelliconultrafiltration unit (Millipore Corp.). Once the insoluble contaminantsare removed the modulator preparation may be further purified usingstandard techniques such as, for example, hydroxylapatitechromatography, gel electrophoresis, dialysis, and affinitychromatography, with affinity chromatography of particular interest. Inthis regard protein A can be used to purify antibodies that are based onhuman IgG1, IgG2 or IgG4 heavy chains (Lindmark, et al., J Immunol Meth62:1 (1983)) while protein G is recommended for all mouse isotypes andfor human IgG3 (Guss, et al., EMBO J 5:1567 (1986)). Other techniquesfor protein purification such as fractionation on an ion-exchangecolumn, ethanol precipitation, reverse phase HPLC, chromatography onsilica, chromatography on heparin, sepharose chromatography on an anionor cation exchange resin (such as a polyaspartic acid column),chromatofocusing, SDS-PAGE and ammonium sulfate precipitation are alsoavailable depending on the antibody to be recovered. In particularlypreferred embodiments the modulators of the instant invention will bepurified, at least in part, using Protein A or Protein G affinitychromatography.

VI. SEZ6 Modulator Fragments and Derivatives

Whatever generation and production methodology is selected, modulatorsof the instant invention will react, bind, combine, complex, connect,attach, join, interact or otherwise associate with a target determinant(e.g., antigen) and thereby provide the desired results. Where themodulator comprises an antibody or fragment, construct or derivativethereof such associations may be through one or more “binding sites” or“binding components” expressed on the antibody, where a binding sitecomprises a region of a polypeptide that is responsible for selectivelybinding to a target molecule or antigen of interest. Binding domainscomprise at least one binding site (e.g., an intact IgG antibody willhave two binding domains and two binding sites). Exemplary bindingdomains include an antibody variable domain, a receptor-binding domainof a ligand, a ligand-binding domain of a receptor or an enzymaticdomain.

A. Antibodies

As noted above, the term “antibody” is intended to cover, at least,polyclonal antibodies, multiclonal antibodies, chimeric antibodies, CDRgrafted antibodies, humanized and primatized antibodies, humanantibodies, recombinantly produced antibodies, intrabodies,multispecific antibodies, bispecific antibodies, monovalent antibodies,multivalent antibodies, anti-idiotypic antibodies, as well as syntheticantibodies.

B. Fragments

Regardless of which form of the modulator (e.g. chimeric, humanized,etc.) is selected to practice the invention it will be appreciated thatimmunoreactive fragments of the same may be used in accordance with theteachings herein. An “antibody fragment” comprises at least a portion ofan intact antibody. As used herein, the term “fragment” of an antibodymolecule includes antigen-binding fragments of antibodies, and the term“antigen-binding fragment” refers to a polypeptide fragment of animmunoglobulin or antibody that immunospecifically binds or reacts witha selected antigen or immunogenic determinant thereof or competes withthe intact antibody from which the fragments were derived for specificantigen binding.

Exemplary fragments include: V_(L), V_(H), scFv, F(ab′)2 fragment, Fabfragment, Fd fragment, Fv fragment, single domain antibody fragments,diabodies, linear antibodies, single-chain antibody molecules andmultispecific antibodies formed from antibody fragments. In addition, anactive fragment comprises a portion of the antibody that retains itsability to interact with the antigen/substrates or receptors and modifythem in a manner similar to that of an intact antibody (though maybewith somewhat less efficiency).

In other embodiments, an antibody fragment is one that comprises the Fcregion and that retains at least one of the biological functionsnormally associated with the Fc region when present in an intactantibody, such as FcRn binding, antibody half-life modulation, ADCCfunction and complement binding. In one embodiment, an antibody fragmentis a monovalent antibody that has an in vivo half-life substantiallysimilar to an intact antibody.

For example, such an antibody fragment may comprise an antigen bindingarm linked to an Fc sequence capable of conferring in vivo stability tothe fragment.

As would be well recognized by those skilled in the art, fragments canbe obtained via chemical or enzymatic treatment (such as papain orpepsin) of an intact or complete antibody or antibody chain or byrecombinant means. See, e.g., Fundamental Immunology, W. E. Paul, ed.,Raven Press, N.Y. (1999), for a more detailed description of antibodyfragments.

C. Derivatives

The invention further includes immunoreactive modulator derivatives andantigen binding molecules comprising one or more modifications.

1. Multivalent Antibodies

In one embodiment, the modulators of the invention may be monovalent ormultivalent (e.g., bivalent, trivalent, etc.). As used herein, the term“valency” refers to the number of potential target binding sitesassociated with an antibody. Each target binding site specifically bindsone target molecule or specific position or locus on a target molecule.When an antibody is monovalent, each binding site of the molecule willspecifically bind to a single antigen position or epitope. When anantibody comprises more than one target binding site (multivalent), eachtarget binding site may specifically bind the same or differentmolecules (e.g., may bind to different ligands or different antigens, ordifferent epitopes or positions on the same antigen). See, for example,U.S.P.N. 2009/0130105. In each case at least one of the binding siteswill comprise an epitope, motif or domain associated with a SEZ6isoform.

In one embodiment, the modulators are bispecific antibodies in which thetwo chains have different specificities, as described in Millstein etal., 1983, Nature, 305:537-539. Other embodiments include antibodieswith additional specificities such as trispecific antibodies. Other moresophisticated compatible multispecific constructs and methods of theirfabrication are set forth in U.S.P.N. 2009/0155255, as well as WO94/04690; Suresh et al., 1986, Methods in Enzymology, 121:210; andWO96/27011.

As alluded to above, multivalent antibodies may immunospecifically bindto different epitopes of the desired target molecule or mayimmunospecifically bind to both the target molecule as well as aheterologous epitope, such as a heterologous polypeptide or solidsupport material. While preferred embodiments of the anti-SEZ6antibodies only bind two antigens (i.e. bispecific antibodies),antibodies with additional specificities such as trispecific antibodiesare also encompassed by the instant invention. Bispecific antibodiesalso include cross-linked or “heteroconjugate” antibodies. For example,one of the antibodies in the heteroconjugate can be coupled to avidin,the other to biotin. Such antibodies have, for example, been proposed totarget immune system cells to unwanted cells (U.S. Pat. No. 4,676,980),and for treatment of HIV infection (WO 91/00360, WO 92/200373, and EP03089). Heteroconjugate antibodies may be made using any convenientcross-linking methods. Suitable cross-linking agents are well known inthe art, and are disclosed in U.S. Pat. No. 4,676,980, along with anumber of cross-linking techniques.

In yet other embodiments, antibody variable domains with the desiredbinding specificities (antibody-antigen combining sites) are fused toimmunoglobulin constant domain sequences, such as an immunoglobulinheavy chain constant domain comprising at least part of the hinge,C_(H)2, and/or C_(H)3 regions, using methods well known to those ofordinary skill in the art.

2. Fc Region Modifications

In addition to the various modifications, substitutions, additions ordeletions to the variable or binding region of the disclosed modulators(e.g., Fc-SEZ6 or anti-SEZ6 antibodies) set forth above, those skilledin the art will appreciate that selected embodiments of the presentinvention may also comprise substitutions or modifications of theconstant region (i.e. the Fc region). More particularly, it iscontemplated that the SEZ6 modulators of the invention may contain interalia one or more additional amino acid residue substitutions, mutationsand/or modifications which result in a compound with preferredcharacteristics including, but not limited to: altered pharmacokinetics,increased serum half life, increase binding affinity, reducedimmunogenicity, increased production, altered Fc ligand binding to an Fcreceptor (FcR), enhanced or reduced “ADCC” (antibody-dependent cellmediated cytotoxicity) or “CDC” (complement-dependent cytotoxicity)activity, altered glycosylation and/or disulfide bonds and modifiedbinding specificity. In this regard it will be appreciated that these Fcvariants may advantageously be used to enhance the effectiveanti-neoplastic properties of the disclosed modulators.

To this end certain embodiments of the invention may comprisesubstitutions or modifications of the Fc region, for example theaddition of one or more amino acid residue, substitutions, mutationsand/or modifications to produce a compound with enhanced or preferred Fceffector functions. For example, changes in amino acid residues involvedin the interaction between the Fc domain and an Fc receptor (e.g.,FcγRI, FcγRIIA and B, FcγRIII and FcRn) may lead to increasedcytotoxicity and/or altered pharmacokinetics, such as increased serumhalf-life (see, for example, Ravetch and Kinet, Annu. Rev. Immunol9:457-92 (1991); Capel et al., Immunomethods 4:25-34 (1994); and de Haaset al., J. Lab. Clin. Med. 126:330-41 (1995) each of which isincorporated herein by reference).

In selected embodiments, antibodies with increased in vivo half-livescan be generated by modifying (e.g., substituting, deleting or adding)amino acid residues identified as involved in the interaction betweenthe Fc domain and the FcRn receptor (see, e.g., InternationalPublication Nos. WO 97/34631; WO 04/029207; U.S. Pat. No. 6,737,056 andU.S.P.N. 2003/0190311. With regard to such embodiments, Fc variants mayprovide half-lives in a mammal, preferably a human, of greater than 5days, greater than 10 days, greater than 15 days, preferably greaterthan 20 days, greater than 25 days, greater than 30 days, greater than35 days, greater than 40 days, greater than 45 days, greater than 2months, greater than 3 months, greater than 4 months, or greater than 5months. The increased half-life results in a higher serum titer whichthus reduces the frequency of the administration of the antibodiesand/or reduces the concentration of the antibodies to be administered.Binding to human FcRn in vivo and serum half life of human FcRn highaffinity binding polypeptides can be assayed, e.g., in transgenic miceor transfected human cell lines expressing human FcRn, or in primates towhich the polypeptides with a variant Fc region are administered. WO2000/42072 describes antibody variants with improved or diminishedbinding to FcRns. See also, e.g., Shields et al. J. Biol. Chem.9(2):6591-6604 (2001).

In other embodiments, Fc alterations may lead to enhanced or reducedADCC or CDC activity. As in known in the art, CDC refers to the lysingof a target cell in the presence of complement, and ADCC refers to aform of cytotoxicity in which secreted Ig bound onto FcRs present oncertain cytotoxic cells (e.g., Natural Killer cells, neutrophils, andmacrophages) enables these cytotoxic effector cells to bind specificallyto an antigen-bearing target cell and subsequently kill the target cellwith cytotoxins. In the context of the instant invention antibodyvariants are provided with “altered” FcR binding affinity, which iseither enhanced or diminished binding as compared to a parent orunmodified antibody or to an antibody comprising a native sequence FcR.Such variants which display decreased binding may possess little or noappreciable binding, e.g., 0-20% binding to the FcR compared to a nativesequence, e.g. as determined by techniques well known in the art. Inother embodiments the variant will exhibit enhanced binding as comparedto the native immunoglobulin Fc domain. It will be appreciated thatthese types of Fc variants may advantageously be used to enhance theeffective anti-neoplastic properties of the disclosed antibodies. In yetother embodiments, such alterations lead to increased binding affinity,reduced immunogenicity, increased production, altered glycosylationand/or disulfide bonds (e.g., for conjugation sites), modified bindingspecificity, increased phagocytosis; and/or down regulation of cellsurface receptors (e.g. B cell receptor; BCR), etc.

3. Altered Glycosylation

Still other embodiments comprise one or more engineered glycoforms,i.e., a SEZ6 modulator comprising an altered glycosylation pattern oraltered carbohydrate composition that is covalently attached to theprotein (e.g., in the Fc domain). See, for example, Shields, R. L. etal. (2002) J. Biol. Chem. 277:26733-26740. Engineered glycoforms may beuseful for a variety of purposes, including but not limited to enhancingor reducing effector function, increasing the affinity of the modulatorfor a target or facilitating production of the modulator. In certainembodiments where reduced effector function is desired, the molecule maybe engineered to express an aglycosylated form. Substitutions that mayresult in elimination of one or more variable region frameworkglycosylation sites to thereby eliminate glycosylation at that site arewell known (see e.g. U.S. Pat. Nos. 5,714,350 and 6,350,861).Conversely, enhanced effector functions or improved binding may beimparted to the Fc containing molecule by engineering in one or moreadditional glycosylation sites.

Other embodiments include an Fc variant that has an alteredglycosylation composition, such as a hypofucosylated antibody havingreduced amounts of fucosyl residues or an antibody having increasedbisecting GlcNAc structures. Such altered glycosylation patterns havebeen demonstrated to increase the ADCC ability of antibodies. Engineeredglycoforms may be generated by any method known to one skilled in theart, for example by using engineered or variant expression strains, byco-expression with one or more enzymes (for exampleN-acetylglucosaminyltransferase III (GnTI11)), by expressing a moleculecomprising an Fc region in various organisms or cell lines from variousorganisms or by modifying carbohydrate(s) after the molecule comprisingFc region has been expressed (see, for example, WO 2012/117002).

4. Additional Processing

The modulators may be differentially modified during or afterproduction, e.g., by glycosylation, acetylation, phosphorylation,amidation, derivatization by known protecting/blocking groups,proteolytic cleavage, linkage to an antibody molecule or other cellularligand, etc. Any of numerous chemical modifications may be carried outby known techniques, including but not limited, to specific chemicalcleavage by cyanogen bromide, trypsin, chymotrypsin, papain, V8protease, NaBH₄, acetylation, formylation, oxidation, reduction,metabolic synthesis in the presence of tunicamycin, etc.

Various post-translational modifications also encompassed by theinvention include, for example, N-linked or O-linked carbohydratechains, processing of N-terminal or C-terminal ends, attachment ofchemical moieties to the amino acid backbone, chemical modifications ofN-linked or O-linked carbohydrate chains, and addition or deletion of anN-terminal methionine residue as a result of prokaryotic host cellexpression. Moreover, the modulators may also be modified with adetectable label, such as an enzymatic, fluorescent, radioisotopic oraffinity label to allow for detection and isolation of the modulator.

VII. Modulator Characteristics

No matter how obtained or which of the aforementioned forms themodulator takes, various embodiments of the disclosed modulators mayexhibit certain characteristics. In selected embodiments,antibody-producing cells (e.g., hybridomas or yeast colonies) may beselected, cloned and further screened for favorable propertiesincluding, for example, robust growth, high modulator production and, asdiscussed in more detail below, desirable modulator characteristics. Inother cases characteristics of the modulator may be imparted orinfluenced by selecting a particular antigen (e.g., a specific SEZ6isoform or fragment thereof) or immunoreactive fragment of the targetantigen for inoculation of the animal. In still other embodiments theselected modulators may be engineered as described above to enhance orrefine immunochemical characteristics such as affinity orpharmacokinetics.

A. Neutralizing Modulators

In certain embodiments, the modulators will comprise “neutralizing”antibodies or derivatives or fragments thereof. That is, the presentinvention may comprise antibody molecules that bind specific domains,motifs or epitopes and are capable of blocking, reducing or inhibitingthe biological activity of SEZ6. More generally the term “neutralizingantibody” refers to an antibody that binds to or interacts with a targetmolecule or ligand and prevents binding or association of the targetmolecule to a binding partner such as a receptor or substrate, therebyinterrupting a biological response that otherwise would result from theinteraction of the molecules.

It will be appreciated that competitive binding assays known in the artmay be used to assess the binding and specificity of an antibody orimmunologically functional fragment or derivative thereof. With regardto the instant invention an antibody or fragment will be held to inhibitor reduce binding of SEZ6 to a binding partner or substrate (e.g., aneurotrophic ligand) when an excess of antibody reduces the quantity ofbinding partner bound to SEZ6 by at least about 20%, 30%, 40%, 50%, 60%,70%, 80%, 85%, 90%, 95%, 97%, 99% or more as measured, for example, byimpaired neurotrophic ligand activity or in an in vitro competitivebinding assay. In the case of antibodies to SEZ6 for example, aneutralizing antibody or antagonist will preferably alter ligandactivity by at least about 20%, 30%, 40%, 50%, 60%, 70%, 80%, 85%, 90%,95%, 97%, 99% or more. It will be appreciated that this modifiedactivity may be measured directly using art-recognized techniques or maybe measured by the impact the altered activity has downstream (e.g.,oncogenesis, cell survival or pathway activation).

B. Internalizing Modulators

While evidence indicates that SEZ6 or selected isoforms thereof may bepresent in a soluble form, at least some SEZ6 likely remains associatedwith the cell surface thereby allowing for internalization of thedisclosed modulators. Accordingly, the anti-SEZ6 antibodies of theinstant invention may be internalized, at least to some extent, by cellsthat express SEZ6. For example, an anti-SEZ6 antibody that binds to SEZ6on the surface of a tumor-initiating cell may be internalized by thetumor-initiating cell. In particularly preferred embodiments suchanti-SEZ6 antibodies may be associated with or conjugated to anti-canceragents such as cytotoxic moieties that kill the cell uponinternalization. In particularly preferred embodiments the modulatorwill comprise an internalizing antibody drug conjugate.

As used herein, a modulator that “internalizes” is one that is taken up(along with any payload) by the cell upon binding to an associatedantigen or receptor. As will be appreciated, the internalizing modulatormay, in preferred embodiments, comprise an antibody including antibodyfragments and derivatives thereof, as well as antibody conjugates.Internalization may occur in vitro or in vivo. For therapeuticapplications, internalization will preferably occur in vivo in a subjectin need thereof. The number of antibody molecules internalized may besufficient or adequate to kill an antigen-expressing cell, especially anantigen-expressing cancer stem cell. Depending on the potency of theantibody or antibody conjugate, in some instances, the uptake of asingle antibody molecule into the cell is sufficient to kill the targetcell to which the antibody binds. For example, certain toxins are sohighly potent that the internalization of a few molecules of the toxinconjugated to the antibody is sufficient to kill the tumor cell. Whetheran antibody internalizes upon binding to a mammalian cell can bedetermined by various assays including those described in the Examplesbelow (e.g., Example 15, 17 and 18). Methods of detecting whether anantibody internalizes into a cell are also described in U.S. Pat. No.7,619,068 which is incorporated herein by reference in its entirety.

C. Depleting Modulators

In other embodiments the antibodies will comprise depleting antibodiesor derivatives or fragments thereof. The term “depleting” antibodyrefers to an antibody that preferably binds to or associates with anantigen on or near the cell surface and induces, promotes or causes thedeath or elimination of the cell (e.g., by CDC, ADCC or introduction ofa cytotoxic agent). In some embodiments, the selected depletingantibodies will be associated or conjugated to a cytotoxic agent.

Preferably a depleting antibody will be able to remove, incapacitate,eliminate or kill at least 20%, 30%, 40%, 50%, 60%, 70%, 80%, 85%, 90%,95%, 97%, or 99% of SEZ6 tumorigenic cells in a defined cell population.In some embodiments the cell population may comprise enriched,sectioned, purified or isolated tumor perpetuating cells. In otherembodiments the cell population may comprise whole tumor samples orheterogeneous tumor extracts that comprise tumor perpetuating cells.Those skilled in the art will appreciate that standard biochemicaltechniques as described in the Examples below (e.g., Examples 14 and 15)may be used to monitor and quantify the depletion of tumorigenic cellsor tumor perpetuating cells in accordance with the teachings herein.

D. Binning and Epitope Binding

It will further be appreciated the disclosed anti-SEZ6 antibodymodulators will associate with, or bind to, discrete epitopes orimmunogenic determinants presented by the selected target or fragmentthereof In certain embodiments, epitope or immunogenic determinantsinclude chemically active surface groupings of molecules such as aminoacids, sugar side chains, phosphoryl groups, or sulfonyl groups, and, incertain embodiments, may have specific three-dimensional structuralcharacteristics, and/or specific charge characteristics. Thus, as usedherein the term “epitope” includes any protein determinant capable ofspecific binding to an immunoglobulin or T-cell receptor or otherwiseinteracting with a molecule. In certain embodiments, an antibody is saidto specifically bind (or immunospecifically bind or react) an antigenwhen it preferentially recognizes its target antigen in a complexmixture of proteins and/or macromolecules. In preferred embodiments, anantibody is said to specifically bind an antigen when the equilibriumdissociation constant (K_(D)) is less than or equal to 10⁻⁶M or lessthan or equal to 10⁻⁷M, more preferably when the equilibriumdissociation constant is less than or equal to 10⁻⁸M, and even morepreferably when the dissociation constant is less than or equal to 10⁻⁹M

More directly the term “epitope” is used in its common biochemical senseand refers to that portion of the target antigen capable of beingrecognized and specifically bound by a particular antibody modulator.When the antigen is a polypeptide such as SEZ6, epitopes may generallybe formed from both contiguous amino acids and noncontiguous amino acidsjuxtaposed by tertiary folding of a protein (“conformational epitopes”).In such conformational epitopes the points of interaction occur acrossamino acid residues on the protein that are linearly separated from oneanother. Epitopes formed from contiguous amino acids (sometimes referredto as “linear” or “continuous” epitopes) are typically retained uponprotein denaturing, whereas epitopes formed by tertiary folding aretypically lost upon protein denaturing. In any event an antibody epitopetypically includes at least 3, and more usually, at least 5 or 8-10amino acids in a unique spatial conformation.

In this respect it will be appreciated that, in certain embodiments, anepitope may be associated with, or reside in, one or more regions,domains or motifs of the SEZ6 protein (e.g., amino acids 1-906 of matureisoform 1). As discussed in more detail herein the extracellular regionof the SEZ6 protein comprises a series of generally recognized domainsincluding five Sushi domains and two CUB domains along with anN-terminal domain. For the purposes of the instant disclosure the term“domain” will be used in accordance with its generally accepted meaningand will be held to refer to an identifiable or definable conservedstructural entity within a protein that exhibits a distinctive secondarystructure content. In many cases, homologous domains with commonfunctions will usually show sequence similarities and be found in anumber of disparate proteins (e.g., Sushi domains are reportedly foundin a large number of different proteins). Similarly, the art-recognizedterm “motif” will be used in accordance with its common meaning andshall generally refer to a short, conserved region of a protein that istypically ten to twenty contiguous amino acid residues. As discussedthroughout, selected embodiments comprise modulators that associate withor bind to an epitope within specific regions, domains or motifs ofSEZ6.

In any event once a desired epitope on an antigen is determined, it ispossible to generate antibodies to that epitope, e.g., by immunizingwith a peptide comprising the epitope using techniques described in thepresent invention. Alternatively, during the discovery process, thegeneration and characterization of antibodies may elucidate informationabout desirable epitopes located in specific domains or motifs. Fromthis information, it is then possible to competitively screen antibodiesfor binding to the same epitope. An approach to achieve this is toconduct competition studies to find antibodies that competitively bindwith one another, i.e. the antibodies compete for binding to theantigen. A high throughput process for binning antibodies based upontheir cross-competition is described in WO 03/48731. Other methods ofbinning or domain level or epitope mapping comprising modulatorcompetition or antigen fragment expression on yeast is set forth inExamples 9 and 10 below.

As used herein, the term “binning” refers to methods used to group orclassify antibodies based on their antigen binding characteristics andcompetition. While the techniques are useful for defining andcategorizing modulators of the instant invention, the bins do not alwaysdirectly correlate with epitopes and such initial determinations ofepitope binding may be further refined and confirmed by otherart-recognized methodology as described herein. However, as discussedand shown in the Examples below, empirical assignment of antibodymodulators to individual bins provides information that may beindicative of the therapeutic potential of the disclosed modulators.

More specifically, one can determine whether a selected referenceantibody (or fragment thereof) binds to the same epitope or crosscompetes for binding with a second test antibody (i.e., is in the samebin) by using methods known in the art and set forth in the Examplesherein. In one embodiment, a reference antibody modulator is associatedwith SEZ6 antigen under saturating conditions and then the ability of asecondary or test antibody modulator to bind to SEZ6 is determined usingstandard immunochemical techniques. If the test antibody is able tosubstantially bind to SEZ6 at the same time as the reference anti-SEZ6antibody, then the secondary or test antibody binds to a differentepitope than the primary or reference antibody. However, if the testantibody is not able to substantially bind to SEZ6 at the same time,then the test antibody binds to the same epitope, an overlappingepitope, or an epitope that is in close proximity (at least sterically)to the epitope bound by the primary antibody. That is, the test antibodycompetes for antigen binding and is in the same bin as the referenceantibody.

The term “compete” or “competing antibody” when used in the context ofthe disclosed modulators means competition between antibodies asdetermined by an assay in which a test antibody or immunologicallyfunctional fragment under test prevents or inhibits specific binding ofa reference antibody to a common antigen. Typically, such an assayinvolves the use of purified antigen (e.g., SEZ6 or a domain or fragmentthereof) bound to a solid surface or cells bearing either of these, anunlabeled test immunoglobulin and a labeled reference immunoglobulin.Competitive inhibition is measured by determining the amount of labelbound to the solid surface or cells in the presence of the testimmunoglobulin. Usually the test immunoglobulin is present in excessand/or allowed to bind first. Antibodies identified by competition assay(competing antibodies) include antibodies binding to the same epitope asthe reference antibody and antibodies binding to an adjacent epitopesufficiently proximal to the epitope bound by the reference antibody forsteric hindrance to occur. Additional details regarding methods fordetermining competitive binding are provided in the Examples herein.Usually, when a competing antibody is present in excess, it will inhibitspecific binding of a reference antibody to a common antigen by at least30%, 40%, 45%, 50%, 55%, 60%, 65%, 70% or 75%. In some instance, bindingis inhibited by at least 80%, 85%, 90%, 95%, or 97% or more.

Conversely, when the reference antibody is bound it will preferablyinhibit binding of a subsequently added test antibody (i.e., a SEZ6modulator) by at least 30%, 40%, 45%, 50%, 55%, 60%, 65%, 70% or 75%. Insome instances binding of the test antibody is inhibited by at least80%, 85%, 90%, 95%, or 97% or more.

With regard to the instant invention, and as set forth in the Examples 9and 10 below, it has been determined (via surface plasmon resonance orbio-layer interferometry) that the extracellular domain of SEZ6 definesat least seven bins by competitive binding termed “bin A” to “bin F” andbin U herein.

In this respect, and as known in the art and detailed in the Examplesbelow, the desired binning or competitive binding data can be obtainedusing solid phase direct or indirect radioimmunoassay (RIA), solid phasedirect or indirect enzyme immunoassay (EIA or ELISA), sandwichcompetition assay, a Biacore™ 2000 system (i.e., surface plasmonresonance—GE Healthcare), a ForteBio® Analyzer (i.e., bio-layerinterferometry—ForteBio, Inc.) or flow cytometric methodology. The term“surface plasmon resonance,” as used herein, refers to an opticalphenomenon that allows for the analysis of real-time specificinteractions by detection of alterations in protein concentrationswithin a biosensor matrix. The term “bio-layer interferometry” refers toan optical analytical technique that analyzes the interference patternof white light reflected from two surfaces: a layer of immobilizedprotein on a biosensor tip, and an internal reference layer. Any changein the number of molecules bound to the biosensor tip causes a shift inthe interference pattern that can be measured in real-time. Inparticularly preferred embodiments the analysis (whether surface plasmonresonance, bio-layer interferometry or flow cytometry) is performedusing a Biacore or ForteBio instrument or a flow cytometer (e.g.,FACSAria II) as demonstrated in the Examples below.

In order to further characterize the epitopes that the disclosed SEZ6antibody modulators associate with or bind to, domain-level epitopemapping was performed using a modification of the protocol described byCochran et al. (J Immunol Methods. 287 (1-2):147-158 (2004) which isincorporated herein by reference). Briefly, individual domains of SEZ6comprising specific amino acid sequences were expressed on the surfaceof yeast and binding by each SEZ6 antibody was determined through flowcytometry. The results are discussed below in Example 10 and shown inFIGS. 14A and 14B.

Other compatible epitope mapping techniques include alanine scanningmutants, peptide blots (Reineke (2004) Methods Mol Biol 248:443-63)(herein specifically incorporated by reference in its entirety), orpeptide cleavage analysis. In addition, methods such as epitopeexcision, epitope extraction and chemical modification of antigens canbe employed (Tomer (2000) Protein Science 9: 487-496) (hereinspecifically incorporated by reference in its entirety). In otherembodiments Modification-Assisted Profiling (MAP), also known as AntigenStructure-based Antibody Profiling (ASAP) provides a method thatcategorizes large numbers of monoclonal antibodies (mAbs) directedagainst the same antigen according to the similarities of the bindingprofile of each antibody to chemically or enzymatically modified antigensurfaces (U.S.P.N. 2004/0101920, herein specifically incorporated byreference in its entirety). Each category may reflect a unique epitopeeither distinctly different from or partially overlapping with epitoperepresented by another category. This technology allows rapid filteringof genetically identical antibodies, such that characterization can befocused on genetically distinct antibodies. It will be appreciated thatMAP may be used to sort the hSEZ6 antibody modulators of the inventioninto groups of antibodies binding different epitopes

Agents useful for altering the structure of the immobilized antigeninclude enzymes such as proteolytic enzymes (e.g., trypsin,endoproteinase Glu-C, endoproteinase Asp-N, chymotrypsin, etc.). Agentsuseful for altering the structure of the immobilized antigen may also bechemical agents, such as, succinimidyl esters and their derivatives,primary amine-containing compounds, hydrazines and carbohydrazines, freeamino acids, etc.

The antigen protein may be immobilized on either biosensor chip surfacesor polystyrene beads. The latter can be processed with, for example, anassay such as multiplex LUMINEX™ detection assay (Luminex Corp.).Because of the capacity of LUMINEX to handle multiplex analysis with upto 100 different types of beads, LUMINEX provides almost unlimitedantigen surfaces with various modifications, resulting in improvedresolution in antibody epitope profiling over a biosensor assay.

E. Modulator Binding Characteristics

Besides epitope specificity the disclosed antibodies may becharacterized using physical characteristics such as, for example,binding affinities. In this regard the present invention furtherencompasses the use of antibodies that have a high binding affinity forone or more SEZ6 isoforms or, in the case of pan-antibodies, more thanone member of the SEZ6 family.

The term “K_(D)”, as used herein, is intended to refer to thedissociation constant of a particular antibody-antigen interaction. Anantibody of the invention is said to immunospecifically bind its targetantigen when the dissociation constant K_(D) (k_(off)/k_(on)) is ≤10⁻⁷M.The antibody specifically binds antigen with high affinity when theK_(D) is ≤5×10⁻⁹M, and with very high affinity when the K_(D) is≤5×10⁻¹⁰M. In one embodiment of the invention, the antibody has a K_(D)of ≤10⁻⁹M and an off-rate of about 1×10⁻⁴/sec. In one embodiment of theinvention, the off-rate is <1×10⁻⁵/sec. In other embodiments of theinvention, the antibodies will bind to SEZ6 with a K_(D) of betweenabout 10⁻⁷M and 10⁻¹⁰M, and in yet another embodiment it will bind witha K_(D)≤2×10⁻¹⁰M. Still other selected embodiments of the presentinvention comprise antibodies that have a disassociation constant orK_(D) (k_(off)/k_(on)) of less than 10⁻²M, less than 5×10⁻²M, less than10⁻³M, less than 5×10⁻³M, less than 10⁻⁴M, less than 5×10⁻⁴M, less than10⁻⁵M, less than 5×10⁻⁵M, less than 10⁻⁶M, less than 5×10⁻⁶M, less than10⁻⁷M, less than 5×10⁻⁷M, less than 10⁻⁸M, less than 5×10⁻⁸M, less than10⁻⁹M, less than 5×10⁻⁹M, less than 10⁻¹⁰M, less than 5×10⁻¹⁰M, lessthan 10⁻¹¹M, less than 5×10⁻¹¹M, less than 10⁻¹²M, less than 5×10⁻¹²M,less than 10⁻¹³M, less than 5×10⁻¹³M, less than 10⁻¹⁴M, less than5×10⁻¹⁴M less than 10⁻¹⁵M or less than 5×10⁻¹⁵M.

In specific embodiments, an antibody of the invention thatimmunospecifically binds to SEZ6 has an association rate constant ork_(on) (or k_(a)) rate (SEZ6 (Ab)+antigen (Ag)^(k) _(on)←Ab-Ag) of atleast 10⁵M⁻¹s⁻¹, at least 2×10⁵M⁻¹s⁻¹, at least 5×10⁵M⁻¹s⁻¹, at least10⁶M⁻¹s⁻¹, at least 5×10⁶M⁻¹s⁻¹, at least 10⁷M⁻¹s⁻¹, at least5×10⁷M⁻¹s⁻¹, or at least 10⁸M⁻¹s⁻¹.

In another embodiment, an antibody of the invention thatimmunospecifically binds to SEZ6 has a disassociation rate constant ork_(off) (or k_(d)) rate (SEZ6 (Ab)+antigen (Ag)^(k) _(off)←Ab-Ag) ofless than 10⁻¹s⁻¹, less than 5×10⁻¹s³¹ ¹, less than 10⁻² s⁻¹, less than5×10⁻² s⁻¹, less than 10⁻³ s⁻¹, less than 5×10⁻³ s⁻¹, less than 10⁻⁴s⁻¹, less than 5×10⁻⁴ s⁻¹, less than 10⁻⁵ s⁻¹, less than 5×10⁻⁵ s⁻¹,less than 10⁻⁶ s⁻¹, less than 5×10⁻⁶ s⁻¹ less than 10⁻⁷ s⁻¹, less than5×10⁻⁷ s⁻¹, less than 10⁻⁸ s⁻¹, less than 5×10⁻⁸ s⁻¹, less than 10⁻⁹s⁻¹, less than 5×10⁻⁹ s⁻¹ or less than 10⁻¹⁰ s⁻¹.

In other selected embodiments of the present invention anti-SEZ6antibodies will have an affinity constant or K_(a) (k_(on)/k_(off)) ofat least 10²M⁻¹, at least 5×10²M⁻¹, at least 10³M⁻¹, at least 5×10³M⁻¹,at least 10⁴M⁻¹, at least 5×10⁴M⁻¹, at least 10⁵M⁻¹, at least 5×10⁵M⁻¹,at least 10⁶M⁻¹, at least 5×10⁶M⁻¹, at least 10⁷M⁻¹, at least 5×10⁷M⁻¹,at least 10⁸M³¹ ¹, at least 5×10⁸M⁻¹, at least 10⁹M⁻¹, at least5×10⁹M⁻¹, at least 10¹⁰M⁻¹, at least 5×10¹⁰M⁻¹, at least 10¹¹M⁻¹, atleast 5×10¹¹M⁻¹, at least 10¹²M⁻¹, at least 5×10¹²M⁻¹, at least 10¹³M⁻¹,at least 5×10¹³M⁻¹, at least 10¹⁴M⁻¹, at least 5×10¹⁴M⁻¹, at least10¹⁵M⁻¹ or at least 5×10¹⁵M⁻¹.

Besides the aforementioned modulator characteristics antibodies of theinstant invention may further be characterized using additional physicalcharacteristics including, for example, thermal stability (i.e, meltingtemperature; Tm), and isoelectric points. (See, e.g., Bjellqvist et al.,1993, Electrophoresis 14:1023; Vermeer et al., 2000, Biophys. J.78:394-404; Vermeer et al., 2000, Biophys. J. 79: 2150-2154 each ofwhich is incorporated by reference).

VIII. Conjugated Modulators

A. Overview

Once the modulators of the invention have been generated and/orfabricated and selected according to the teachings herein they may belinked with, fused to, conjugated to (e.g., covalently ornon-covalently) or otherwise associated with pharmaceutically active ordiagnostic moieties, therapeutic moieties or biocompatible modifiers.The modulators (e.g. antibodies) of the invention may be conjugateddirectly or indirectly to therapeutic moieties. An antibody is“conjugated directly” to a therapeutic moiety or other moiety, forexample, a reporter, when such antibody is associated, linked or fusedwith such moiety without using a linker (linkers are described in moredetail below) to connect the antibody to the therapeutic moiety or othermoiety. An antibody is “conjugated indirectly” to a therapeutic moietyor other moiety, for example, a reporter, when the antibody isassociated, linked or fused to such moiety using a linker that connectsthe antibody to such moiety. As used herein the term “conjugate” or“modulator conjugate” or “antibody conjugate” will be used broadly andheld to mean any biologically active or detectable molecule or drugassociated with the disclosed modulators regardless of the method ofassociation. In this respect it will be understood that such conjugatesmay, in addition to the disclosed modulators, comprise peptides,polypeptides, proteins, prodrugs which are metabolized to an activeagent in vivo, polymers, nucleic acid molecules, small molecules,binding agents, mimetic agents, synthetic drugs, inorganic molecules,organic molecules and radioisotopes. Moreover, as indicated above theselected conjugate may be covalently or non-covalently associated with,or linked to, the modulator and exhibit various stoichiometric molarratios depending, at least in part, on the method used to effect theconjugation.

Particularly preferred aspects of the instant invention will compriseantibody modulator conjugates or antibody-drug conjugates that may beused for the diagnosis and/or treatment of proliferative disorders. Itwill be appreciated that, unless otherwise dictated by context, the term“antibody-drug conjugate” or “ADC” or the formula M-[L-D]n shall be heldto encompass conjugates comprising both therapeutic and diagnosticmoieties. In such embodiments antibody-drug conjugate compounds willcomprise a SEZ6 modulator (typically an anti-SEZ6 antibody) as themodulator or cellular binding unit (abbreviated as CBA, M, or Abherein), a therapeutic (e.g., anti-cancer agent) or diagnostic moiety(D), and optionally a linker (L) that joins the drug and the antigenbinding agent. For the purposes of the instant disclosure “n” shall beheld to mean an integer from 1 to 20. In a preferred embodiment, themodulator is a SEZ6 mAb comprising at least one CDR from the heavy andlight chain variable regions as described above.

Those skilled in the art will appreciate that a number of differentreactions are available for the attachment or association of therapeuticor diagnostic moieties and/or linkers to binding agents. In selectedembodiments this may be accomplished by reaction of the amino acidresidues of the binding agent, e.g., antibody molecule, including theamine groups of lysine, the free carboxylic acid groups of glutamic andaspartic acid, the sulfhydryl groups of cysteine and the variousmoieties of the aromatic amino acids. One of the most commonly usednon-specific methods of covalent attachment is the carbodiimide reactionto link a carboxy (or amino) group of a compound to amino (or carboxy)groups of the antibody. Additionally, bifunctional agents such asdialdehydes or imidoesters have been used to link the amino group of acompound to amino groups of an antibody molecule. Also available forattachment of drugs to binding agents is the Schiff base reaction. Thismethod involves the periodate oxidation of a drug that contains glycolor hydroxy groups, thus forming an aldehyde which is then reacted withthe binding agent. Attachment occurs via formation of a Schiff base withamino groups of the binding agent. Isothiocyanates and azlactones canalso be used as coupling agents for covalently attaching drugs tobinding agents.

In other embodiments the disclosed modulators of the invention may beconjugated or associated with proteins, polypeptides or peptides thatimpart selected characteristics (e.g., biotoxins, biomarkers,purification tags, etc.). In certain preferred embodiments the presentinvention encompasses the use of modulators or fragments thereofrecombinantly fused or chemically conjugated (including both covalentand non-covalent conjugations) to a heterologous protein or peptidewherein the protein or peptide comprises at least 10, at least 20, atleast 30, at least 40, at least 50, at least 60, at least 70, at least80, at least 90 or at least 100 amino acids. The construct does notnecessarily need to be directly linked, but may occur through amino acidlinker sequences. For example, antibodies may be used to targetheterologous polypeptides to particular cell types expressing SEZ6,either in vitro or in vivo, by fusing or conjugating the modulators ofthe present invention to antibodies specific for particular cell surfacereceptors to provide bispecific constructs. Moreover, modulators fusedor conjugated to heterologous polypeptides may also be used in in vitroimmunoassays and may be particularly compatible with purificationmethodology (e.g., his-tags) as is known in the art. See e.g.,International publication No. WO 93/21232; European Patent No. EP439,095; Naramura et al., 1994, Immunol. Lett. 39:91-99; U.S. Pat. No.5,474,981; Gillies et al., 1992, PNAS 89:1428-1432; and Fell et al.,1991, J. Immunol. 146:2446-2452.

B. Linkers

Besides the aforementioned peptide linkers or spacers, it will beappreciated that several other varieties or types of linker may be usedto associate the disclosed modulators with pharmaceutically active ordiagnostic moieties or biocompatible modifiers. In some embodiments, thelinker is cleavable under intracellular conditions, such that cleavageof the linker releases the drug unit from the antibody in theintracellular environment. In yet other embodiments, the linker unit isnot cleavable and the drug is released, for example, by antibodydegradation.

The linkers of the ADC are preferably stable extracellularly, preventaggregation of ADC molecules and keep the ADC freely soluble in aqueousmedia and in a monomeric state. Before transport or delivery into acell, the antibody-drug conjugate (ADC) is preferably stable and remainsintact, i.e. the antibody remains linked to the drug moiety. The linkersare stable outside the target cell and may be cleaved at someefficacious rate inside the cell. An effective linker will: (i) maintainthe specific binding properties of the antibody; (ii) allowintracellular delivery of the conjugate or drug moiety; (iii) remainstable and intact, i.e. not cleaved, until the conjugate has beendelivered or transported to its targeted site; and (iv) maintain acytotoxic, cell-killing effect or a cytostatic effect of the PBD drugmoiety. Stability of the ADC may be measured by standard analyticaltechniques such as mass spectroscopy, HPLC, and the separation/analysistechnique LC/MS. Covalent attachment of the antibody and the drug moietyrequires the linker to have two reactive functional groups, i.e.bivalency in a reactive sense. Bivalent linker reagents which are usefulto attach two or more functional or biologically active moieties, suchas peptides, nucleic acids, drugs, toxins, antibodies, haptens, andreporter groups are known, and methods have been described theirresulting conjugates (Hermanson, G. T. (1996) Bioconjugate Techniques;Academic Press: New York, p 234-242).

To this end certain embodiments of the invention comprise the use alinker that is cleavable by a cleaving agent that is present in theintracellular environment (e.g., within a lysosome or endosome orcaveolae). The linker can be, for example, a peptidyl linker that iscleaved by an intracellular peptidase or protease enzyme, including, butnot limited to, a lysosomal or endosomal protease. In some embodiments,the peptidyl linker is at least two amino acids long or at least threeamino acids long. Cleaving agents can include cathepsins B and D andplasmin, each of which is known to hydrolyze dipeptide drug derivativesresulting in the release of active drug inside target cells. Exemplarypeptidyl linkers that are cleavable by the thiol-dependent proteaseCathepsin-B are peptides comprising Phe-Leu since Cathepsin-B has beenfound to be highly expressed in cancerous tissue. Other examples of suchlinkers are described, for example, in U.S. Pat. No. 6,214,345 andU.S.P.N. 2012/0078028 each of which incorporated herein by reference inits entirety. In a specific preferred embodiment, the peptidyl linkercleavable by an intracellular protease is a Val-Cit linker, an Ala-Vallinker or a Phe-Lys linker such as is described in U.S. Pat. No.6,214,345. One advantage of using intracellular proteolytic release ofthe therapeutic agent is that the agent is typically attenuated whenconjugated and the serum stabilities of the conjugates are typicallyhigh.

In other embodiments, the cleavable linker is pH-sensitive, i.e.,sensitive to hydrolysis at certain pH values. Typically, thepH-sensitive linker hydrolyzable under acidic conditions. For example,an acid-labile linker that is hydrolyzable in the lysosome (e.g., ahydrazone, oxime, semicarbazone, thiosemicarbazone, cis-aconitic amide,orthoester, acetal, ketal, or the like) can be used (See, e.g., U.S.Pat. Nos. 5,122,368; 5,824,805; 5,622,929). Such linkers are relativelystable under neutral pH conditions, such as those in the blood, but areunstable at below pH 5.5 or 5.0, the approximate pH of the lysosome.

In yet other embodiments, the linker is cleavable under reducingconditions (e.g., a disulfide linker). A variety of disulfide linkersare known in the art, including, for example, those that can be formedusing SATA (N-succinimidyl-S-acetylthioacetate), SPDP(N-succinimidyl-3-(2-pyridyldithio)propionate), SPDB(N-succinimidyl-3-(2-pyridyldithio) butyrate) and SMPT(N-succinimidyl-oxycarbonyl-alpha-methyl-alpha-(2-pyridyl-dithio)toluene).In yet other specific embodiments, the linker is a malonate linker(Johnson et al., 1995, Anticancer Res. 15:1387-93), a maleimidobenzoyllinker (Lau et al., 1995, Bioorg-Med-Chem. 3(10):1299-1304), or a3′-N-amide analog (Lau et al., 1995, Bioorg-Med-Chem. 3(10):1305-12). Inyet other embodiments, the linker unit is not cleavable and the drug isreleased by antibody degradation. (See U.S. Publication No. 2005/0238649incorporated by reference herein in its entirety and for all purposes).

More particularly, in preferred embodiments (set forth in U.S.P.N.2011/0256157 which is incorporated herein by reference in its entirety)compatible linkers will comprise:

where the asterisk indicates the point of attachment to the cytotoxicagent, CBA is a cell binding agent/modulator, L¹ is a linker, A is aconnecting group connecting L¹ to the cell binding agent, L² is acovalent bond or together with —OC(═O)— forms a self-immolative linker,and L¹ or L² is a cleavable linker.

L¹ is preferably the cleavable linker, and may be referred to as atrigger for activation of the linker for cleavage.

The nature of L¹ and L², where present, can vary widely. These groupsare chosen on the basis of their cleavage characteristics, which may bedictated by the conditions at the site to which the conjugate isdelivered. Those linkers that are cleaved by the action of enzymes arepreferred, although linkers that are cleavable by changes in pH (e.g.acid or base labile), temperature or upon irradiation (e.g. photolabile)may also be used. Linkers that are cleavable under reducing or oxidisingconditions may also find use in the present invention.

L¹ may comprise a contiguous sequence of amino acids. The amino acidsequence may be the target substrate for enzymatic cleavage, therebyallowing release of R¹⁰ from the N10 position.

In one embodiment, L¹ is cleavable by the action of an enzyme. In oneembodiment, the enzyme is an esterase or a peptidase.

In one embodiment, L² is present and together with —C(═O)O— forms aself-immolative linker. In one embodiment, L² is a substrate forenzymatic activity, thereby allowing release of R¹⁰ from the N10position.

In one embodiment, where L¹ is cleavable by the action of an enzyme andL² is present, the enzyme cleaves the bond between L¹ and L².

L¹ and L², where present, may be connected by a bond selected from:

—C(═O)NH—, —C(═O)O—, —NHC(═O)—, —OC(═O)—, —OC(═O)O—, —NHC(═O)O—,—OC(═O)NH—, and —NHC(═O)NH—.

An amino group of L¹ that connects to L² may be the N-terminus of anamino acid or may be derived from an amino group of an amino acid sidechain, for example a lysine amino acid side chain.

A carboxyl group of L¹ that connects to L² may be the C-terminus of anamino acid or may be derived from a carboxyl group of an amino acid sidechain, for example a glutamic acid amino acid side chain.

A hydroxyl group of L¹ that connects to L² may be derived from ahydroxyl group of an amino acid side chain, for example a serine aminoacid side chain.

The term “amino acid side chain” includes those groups found in: (i)naturally occurring amino acids such as alanine, arginine, asparagine,aspartic acid, cysteine, glutamine, glutamic acid, glycine, histidine,isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine,threonine, tryptophan, tyrosine, and valine; (ii) minor amino acids suchas ornithine and citrulline; (iii) unnatural amino acids, beta-aminoacids, synthetic analogs and derivatives of naturally occurring aminoacids; and (iv) all enantiomers, diastereomers, isomerically enriched,isotopically labelled (e.g. ²H, ³H, ¹⁴C, ¹⁵N), protected forms, andracemic mixtures thereof.

In one embodiment, —C(═O)O— and L² together form the group:

where the asterisk indicates the point of attachment to the drug orcytotoxic agent position, the wavy line indicates the point ofattachment to the linker L¹, Y is —N(H)—, —O—, —C(═O)N(H)— or —C(═O)O—,and n is 0 to 3. The phenylene ring is optionally substituted with one,two or three substituents as described herein. In one embodiment, thephenylene group is optionally substituted with halo, NO₂, R or OR.

In one embodiment, Y is NH.

In one embodiment, n is 0 or 1. Preferably, n is 0.

Where Y is NH and n is 0, the self-immolative linker may be referred toas a p-aminobenzylcarbonyl linker (PABC).

The self-immolative linker will allow for release of the protectedcompound when a remote site is activated, proceeding along the linesshown below (for n=0):

where L* is the activated form of the remaining portion of the linker.These groups have the advantage of separating the site of activationfrom the compound being protected. As described above, the phenylenegroup may be optionally substituted.

In one embodiment described herein, the group L* is a linker L¹ asdescribed herein, which may include a dipeptide group.

In another embodiment, —C(═O)O— and L² together form a group selectedfrom:

where the asterisk, the wavy line, Y, and n are as defined above. Eachphenylene ring is optionally substituted with one, two or threesubstituents as described herein. In one embodiment, the phenylene ringhaving the Y substituent is optionally substituted and the phenylenering not having the Y substituent is unsubstituted. In one embodiment,the phenylene ring having the Y substituent is unsubstituted and thephenylene ring not having the Y substituent is optionally substituted.

In another embodiment, —C(═O)O— and L² together form a group selectedfrom:

where the asterisk, the wavy line, Y, and n are as defined above, E isO, S or NR, D is N, CH, or CR, and F is N, CH, or CR.

In one embodiment, D is N.

In one embodiment, D is CH.

In one embodiment, E is O or S.

In one embodiment, F is CH.

In a preferred embodiment, the linker is a cathepsin labile linker.

In one embodiment, L¹ comprises a dipeptide. The dipeptide may berepresented as —NH—X₁—X₂—CO—, where —NH— and —CO— represent the N- andC-terminals of the amino acid groups X₁ and X₂ respectively. The aminoacids in the dipeptide may be any combination of natural amino acids.Where the linker is a cathepsin labile linker, the dipeptide may be thesite of action for cathepsin-mediated cleavage.

Additionally, for those amino acids groups having carboxyl or amino sidechain functionality, for example Glu and Lys respectively, CO and NH mayrepresent that side chain functionality.

In one embodiment, the group —X₁—X₂— in dipeptide, —NH—X₁—X₂—CO—, isselected from:

-Phe-Lys-, -Val-Ala-, -Val-Lys-, -Ala-Lys-, -Val-Cit-, -Phe-Cit-,-Leu-Cit-, -Ile-Cit-, -Phe-Arg- and -Trp-Cit- where Cit is citrulline.

Preferably, the group —X₁—X₂— in dipeptide, —NH—X₁—X₂—CO—, is selectedfrom:

-Phe-Lys-, -Val-Ala-, -Val-Lys-, -Ala-Lys-, and -Val-Cit-.

Most preferably, the group —X₁—X₂— in dipeptide, —NH—X₁—X₂—CO—, is-Phe-Lys- or -Val-Ala-.

Other dipeptide combinations may be used, including those described byDubowchik et al., Bioconjugate Chemistry, 2002, 13,855-869, which isincorporated herein by reference.

In one embodiment, the amino acid side chain is derivatised, whereappropriate. For example, an amino group or carboxy group of an aminoacid side chain may be derivatised.

In one embodiment, an amino group NH₂ of a side chain amino acid, suchas lysine, is a derivatised form selected from the group consisting ofNHR and NRR′.

In one embodiment, a carboxy group COOH of a side chain amino acid, suchas aspartic acid, is a derivatised form selected from the groupconsisting of COOR, CONH₂, CONHR and CONRR′.

In one embodiment, the amino acid side chain is chemically protected,where appropriate. The side chain protecting group may be a group asdiscussed below in relation to the group R^(L). Protected amino acidsequences are cleavable by enzymes. For example, it has been establishedthat a dipeptide sequence comprising a Boc side chain-protected Lysresidue is cleavable by cathepsin.

Protecting groups for the side chains of amino acids are well known inthe art and are described in the Novabiochem Catalog. Additionalprotecting group strategies are set out in Protective Groups in OrganicSynthesis, Greene and Wuts.

Possible side chain protecting groups are shown below for those aminoacids having reactive side chain functionality:

Arg: Z, Mtr, Tos;

Asn: Trt, Xan;

Asp: Bzl, t-Bu;

Cys: Acm, Bzl, Bzl-OMe, Bzl-Me, Trt;

Glu: Bzl, t-Bu;

Gln: Trt, Xan;

His: Boc, Dnp, Tos, Trt;

Lys: Boc, Z-Cl, Fmoc, Z, Alloc;

Ser: Bzl, TBDMS, TBDPS;

Thr: Bz;

Trp: Boc;

Tyr: Bzl, Z, Z—Br.

In one embodiment, the side chain protection is selected to beorthogonal to a group provided as, or as part of, a capping group, wherepresent. Thus, the removal of the side chain protecting group does notremove the capping group, or any protecting group functionality that ispart of the capping group.

In other embodiments of the invention, the amino acids selected arethose having no reactive side chain functionality. For example, theamino acids may be selected from: Ala, Gly, Ile, Leu, Met, Phe, Pro, andVal.

In one embodiment, the dipeptide is used in combination with aself-immolative linker. The self-immolative linker may be connected to—X₂—.

Where a self-immolative linker is present, —X₂— is connected directly tothe self-immolative linker. Preferably the group —X₂—CO— is connected toY, where Y is NH, thereby forming the group —X₂—CO—NH—.

—NH—X₁— is connected directly to A. A may comprise the functionality—CO— thereby to form an amide link with —X₁—.

In one embodiment, L¹ and L² together with —OC(═O)— comprise the groupNH—X₁—X₂—CO—PABC—. The PABC group is connected directly to the cytotoxicagent. Preferably, the self-immolative linker and the dipeptide togetherform the group —NH-Phe-Lys-CO—NH—PABC—, which is illustrated below:

where the asterisk indicates the point of attachment to the selectedcytotoxic moiety, and the wavy line indicates the point of attachment tothe remaining portion of the linker L¹ or the point of attachment to A.Preferably, the wavy line indicates the point of attachment to A. Theside chain of the Lys amino acid may be protected, for example, withBoc, Fmoc, or Alloc, as described above.

Alternatively, the self-immolative linker and the dipeptide togetherform the group —NH-Val-Ala-CO—NH—PABC—, which is illustrated below:

where the asterisk and the wavy line are as defined above.

Alternatively, the self-immolative linker and the dipeptide togetherform the group —NH-Val-Cit-CO-NH—PABC—, which is illustrated below:

where the asterisk and the wavy line are as defined above.

In some embodiments of the present invention, it may be preferred thatif the drug moiety contains an unprotected imine bond, e.g. if moiety Bis present, then the linker does not contain a free amino (H₂N—) group.Thus if the linker has the structure -A-L¹-L²- then this wouldpreferably not contain a free amino group. This preference isparticularly relevant when the linker contains a dipeptide, for exampleas L¹; in this embodiment, it would be preferred that one of the twoamino acids is not selected from lysine.

Without wishing to be bound by theory, the combination of an unprotectedimine bond in the drug moiety and a free amino group in the linker cancause dimerisation of the drug-linker moiety which may interfere withthe conjugation of such a drug-linker moiety to an antibody. Thecross-reaction of these groups may be accelerated in the case the freeamino group is present as an ammonium ion (H₃N⁺—), such as when a strongacid (e.g. TFA) has been used to deprotect the free amino group.

In one embodiment, A is a covalent bond. Thus, L¹ and the cell bindingagent are directly connected. For example, where L¹ comprises acontiguous amino acid sequence, the N-terminus of the sequence mayconnect directly to the cell binding agent.

Thus, where A is a covalent bond, the connection between the cellbinding agent and L′ may be selected from:

—C(═O)NH—, —C(═O)O—, —NHC(═O)—, —OC(═O)—, —OC(═O)O—, —NHC(═O)O—,—OC(═O)NH—, —NHC(═O)NH—, —C(═O)NHC(═O)—, —S—, —S—S—, —CH₂C(═O)—, and═N—NH—.

An amino group of L¹ that connects to the SEZ6 modulator may be theN-terminus of an amino acid or may be derived from an amino group of anamino acid side chain, for example a lysine amino acid side chain.

A carboxyl group of L¹ that connects to the modulator may be theC-terminus of an amino acid or may be derived from a carboxyl group ofan amino acid side chain, for example a glutamic acid amino acid sidechain.

A hydroxyl group of L¹ that connects to the cell binding agent may bederived from a hydroxyl group of an amino acid side chain, for example aserine amino acid side chain.

A thiol group of L¹ that connects to a modulator agent may be derivedfrom a thiol group of an amino acid side chain, for example a serineamino acid side chain.

The comments above in relation to the amino, carboxyl, hydroxyl andthiol groups of L¹ also apply to the cell binding agent.

In one embodiment, L² together with —OC(═O)— represents:

where the asterisk indicates the point of attachment to the N10position, the wavy line indicates the point of attachment to L^(l), n is0 to 3, Y is a covalent bond or a functional group, and E is anactivatable group, for example by enzymatic action or light, thereby togenerate a self-immolative unit. The phenylene ring is optionallyfurther substituted with one, two or three substituents as describedherein. In one embodiment, the phenylene group is optionally furthersubstituted with halo, NO₂, R or OR. Preferably n is 0 or 1, mostpreferably 0.

E is selected such that the group is susceptible to activation, e.g. bylight or by the action of an enzyme. E may be —NO₂ or glucoronic acid.The former may be susceptible to the action of a nitroreductase, thelatter to the action of a β-glucoronidase.

In this embodiment, the self-immolative linker will allow for release ofthe protected compound when E is activated, proceeding along the linesshown below (for n=0):

where the asterisk indicates the point of attachment to the N10position, E* is the activated form of E, and Y is as described above.These groups have the advantage of separating the site of activationfrom the compound being protected. As described above, the phenylenegroup may be optionally further substituted.

The group Y may be a covalent bond to L¹.

The group Y may be a functional group selected from:

—C(═O)—, —NH—, —O—, —C(═O)NH—, —C(═O)O—, —NHC(═O)—, —OC(═O)—, —OC(═O)O—,—NHC(═O)O—, —OC(═O)NH—, —NHC(═O)NH—, —NHC(═O)NH, —C(═O)NHC(═O)—, and—S—.

Where L¹ is a dipeptide, it is preferred that Y is —NH— or —C(═O)—,thereby to form an amide bond between L¹ and Y. In this embodiment, thedipeptide sequence need not be a substrate for an enzymatic activity.

In another embodiment, A is a spacer group. Thus, L¹ and the cellbinding agent are indirectly connected.

L¹ and A may be connected by a bond selected from:

—C(═O)NH—, —C(═O)O—, —NHC(═O)—, —OC(═O)—, —OC(═O)O—, —NHC(═O)O—,—OC(═O)NH—, and —NHC(═O)NH—.

Preferably, the linker contains an electrophilic functional group forreaction with a nucleophilic functional group on the modulator.Nucleophilic groups on antibodies include, but are not limited to: (i)N-terminal amine groups, (ii) side chain amine groups, e.g. lysine,(iii) side chain thiol groups, e.g. cysteine, and (iv) sugar hydroxyl oramino groups where the antibody is glycosylated. Amine, thiol, andhydroxyl groups are nucleophilic and capable of reacting to formcovalent bonds with electrophilic groups on linker moieties and linkerreagents including: (i) maleimide groups (ii) activated disulfides,(iii) active esters such as NHS (N-hydroxysuccinimide) esters, HOBt(N-hydroxybenzotriazole) esters, haloformates, and acid halides; (iv)alkyl and benzyl halides such as haloacetamides; and (v) aldehydes,ketones, carboxyl, and, some of which are exemplified as follows:

Certain antibodies have reducible interchain disulfides, i.e. cysteinebridges. Antibodies may be made reactive for conjugation with linkerreagents by treatment with a reducing agent such as DTT(dithiothreitol). Each cysteine bridge will thus form, theoretically,two reactive thiol nucleophiles. Additional nucleophilic groups can beintroduced into antibodies through the reaction of lysines with2-iminothiolane (Traut's reagent) resulting in conversion of an amineinto a thiol. Reactive thiol groups may be introduced into the antibody(or fragment thereof) by introducing one, two, three, four, or morecysteine residues (e.g., preparing mutant antibodies comprising one ormore non-native cysteine amino acid residues). U.S. Pat. No. 7,521,541teaches engineering antibodies by introduction of reactive cysteineamino acids.

In some embodiments, a linker has a reactive nucleophilic group which isreactive with an electrophilic group present on an antibody. Usefulelectrophilic groups on an antibody include, but are not limited to,aldehyde and ketone carbonyl groups. The heteroatom of a nucleophilicgroup of a Linker can react with an electrophilic group on an antibodyand form a covalent bond to an antibody unit. Useful nucleophilic groupson a linker include, but are not limited to, hydrazide, oxime, amino,hydroxyl, hydrazine, thiosemicarbazone, hydrazine carboxylate, andarylhydrazide. The electrophilic group on an antibody provides aconvenient site for attachment to a Linker.

In one embodiment, the group A is:

where the asterisk indicates the point of attachment to L¹, the wavyline indicates the point of attachment to the cell binding agent, and nis 0 to 6. In one embodiment, n is 5.

In one embodiment, the group A is:

where the asterisk indicates the point of attachment to L¹, the wavyline indicates the point of attachment to the cell binding agent, and nis 0 to 6. In one embodiment, n is 5.

In one embodiment, the group A is:

where the asterisk indicates the point of attachment to L¹, the wavyline indicates the point of attachment to the cell binding agent, n is 0or 1, and m is 0 to 30. In a preferred embodiment, n is 1 and m is 0 to10, 1 to 8, preferably 4 to 8, and most preferably 4 or 8. In anotherembodiment, m is 10 to 30, and preferably 20 to 30. Alternatively, m is0 to 50. In this embodiment, m is preferably 10-40 and n is 1.

In one embodiment, the group A is:

where the asterisk indicates the point of attachment to L¹, the wavyline indicates the point of attachment to the cell binding agent, n is 0or 1, and m is 0 to 30. In a preferred embodiment, n is 1 and m is 0 to10, 1 to 8, preferably 4 to 8, and most preferably 4 or 8. In anotherembodiment, m is 10 to 30, and preferably 20 to 30. Alternatively, m is0 to 50. In this embodiment, m is preferably 10-40 and n is 1.

In one embodiment, the connection between the cell binding agent and Ais through a thiol residue of the cell binding agent and a maleimidegroup of A.

In one embodiment, the connection between the cell binding agent and Ais:

where the asterisk indicates the point of attachment to the remainingportion of A and the wavy line indicates the point of attachment to theremaining portion of the cell binding agent. In this embodiment, the Satom is typically derived from the modulator.

In each of the embodiments above, an alternative functionality may beused in place of the maleimide-derived group shown below:

where the wavy line indicates the point of attachment to the cellbinding agent as before, and the asterisk indicates the bond to theremaining portion of the A group.

In one embodiment, the maleimide-derived group is replaced with thegroup:

where the wavy line indicates point of attachment to the cell bindingagent, and the asterisk indicates the bond to the remaining portion ofthe A group.

In one embodiment, the maleimide-derived group is replaced with a group,which optionally together with the cell binding agent, is selected from:

—C(═O)NH—, —C(═O)O—, —NHC(═O)—, —OC(═O)—, —OC(═O)O—, —NHC(═O)O—,—OC(═O)NH—, —NHC(═O)NH—, —NHC(═O)NH, —C(═O)NHC(═O)—, —S—, —S—S—,—CH₂C(═O)—, —C(═O)CH₂—, ═N—NH— and —NH—N═.

In one embodiment, the maleimide-derived group is replaced with a group,which optionally together with the cell binding agent, is selected from:

where the wavy line indicates either the point of attachment to the cellbinding agent or the bond to the remaining portion of the A group, andthe asterisk indicates the other of the point of attachment to the cellbinding agent or the bond to the remaining portion of the A group.

Other groups suitable for connecting L¹ to the selected modulator aredescribed in WO 2005/082023.

In another preferred embodiment the modulators of the instant inventionmay be associated with biocompatible polymers comprising drug linkerunits. In this respect one such type of compatible polymer comprisesFleximer® polymers (Mersana Therapeutics). Such polymers are reportedlybiodegradable, well tolerated and have been clinically validated.Moreover, such polymers are compatible with a number of customizablelinker technologies and chemistries allowing for control ofpharmacokinetics, localization of drug release and improvedbiodistribution.

The selected modulators can also be directly conjugated radioisotopes ormay comprise macrocyclic chelators useful for conjugating radiometalions (as described herein). In certain embodiments, the macrocyclicchelator is 1,4,7,10-tetraazacyclododecane-N,N′,N″,N″-tetraacetic acid(DOTA) which can be attached to the antibody via a linker molecule. Suchlinker molecules are commonly known in the art and described in Denardoet al., 1998, Clin Cancer Res. 4:2483; Peterson et al., 1999, Bioconjug.Chem. 10:553; and Zimmerman et al., 1999, Nucl. Med. Biol. 26:943.

More generally, techniques for conjugating therapeutic moieties orcytotoxic agents to modulators are well known. As discussed abovemoieties can be conjugated to modulators by any art-recognized method,including, but not limited to aldehyde/Schiff linkage, sulphydryllinkage, acid-labile linkage, cis-aconityl linkage, hydrazone linkage,enzymatically degradable linkage (see generally Garnett, 2002, Adv DrugDeliv Rev 53:171). Also see, e.g., Amon et al., “Monoclonal AntibodiesFor Immunotargeting Of Drugs In Cancer Therapy”, in MonoclonalAntibodies And Cancer Therapy, Reisfeld et al. (eds.), pp. 243-56 (AlanR. Liss, Inc. 1985); Hellstrom et al., “Antibodies For Drug Delivery”,in Controlled Drug Delivery (2nd Ed.), Robinson et al. (eds.), pp.623-53 (Marcel Dekker, Inc. 1987); Thorpe, “Antibody Carriers OfCytotoxic Agents In Cancer Therapy: A Review”, in Monoclonal Antibodies'84: Biological And Clinical Applications, Pinchera et al. (eds.), pp.475-506 (1985); “Analysis, Results, And Future Prospective Of TheTherapeutic Use Of Radiolabeled Antibody In Cancer Therapy”, inMonoclonal Antibodies For Cancer Detection And Therapy, Baldwin et al.(eds.), pp. 303-16 (Academic Press 1985), and Thorpe et al., 1982,Immunol. Rev. 62:119. In preferred embodiments a SEZ6 modulator that isconjugated to a therapeutic moiety or cytotoxic agent may beinternalized by a cell upon binding to a SEZ6 molecule associated withthe cell surface thereby delivering the therapeutic payload.

C. Biocompatible Modifiers

In selected embodiments the modulators of the invention may beconjugated or otherwise associated with biocompatible modifiers that maybe used to adjust, alter, improve or moderate modulator characteristicsas desired. For example, antibodies or fusion constructs with increasedin vivo half-lives can be generated by attaching relatively highmolecular weight polymer molecules such as commercially availablepolyethylene glycol (PEG) or similar biocompatible polymers. Thoseskilled in the art will appreciate that PEG may be obtained in manydifferent molecular weight and molecular configurations that can beselected to impart specific properties to the antibody (e.g. thehalf-life may be tailored). PEG can be attached to modulators orantibody fragments or derivatives with or without a multifunctionallinker either through site-specific conjugation of the PEG to the N- orC-terminus of said antibodies or antibody fragments or via epsilon-aminogroups present on lysine residues. Linear or branched polymerderivatization that results in minimal loss of biological activity maybe used. The degree of conjugation can be closely monitored by SDS-PAGEand mass spectrometry to ensure optimal conjugation of PEG molecules toantibody molecules. Unreacted PEG can be separated from antibody-PEGconjugates by, e.g., size exclusion or ion-exchange chromatography. In asimilar manner, the disclosed modulators can be conjugated to albumin inorder to make the antibody or antibody fragment more stable in vivo orhave a longer half life in vivo. The techniques are well known in theart, see e.g., International Publication Nos. WO 93/15199, WO 93/15200,and WO 01/77137; and European Patent No. 0 413, 622. Other biocompatibleconjugates are evident to those of ordinary skill and may readily beidentified in accordance with the teachings herein.

D. Diagnostic or Detection Agents

In other preferred embodiments, modulators of the present invention, orfragments or derivatives thereof, are conjugated to a diagnostic ordetectable agent, marker or reporter which may be, for example, abiological molecule (e.g., a peptide or nucleotide), a small molecule,fluorophore, or radioisotope. Labeled modulators can be useful formonitoring the development or progression of a hyperproliferativedisorder or as part of a clinical testing procedure to determine theefficacy of a particular therapy including the disclosed modulators(i.e. theragnostics) or to determine a future course of treatment. Suchmarkers or reporters may also be useful in purifying the selectedmodulator, modulator analytics (e.g., epitope binding or antibodybinning), separating or isolating TIC or in preclinical procedures ortoxicology studies.

Such diagnosis analysis and/or detection can be accomplished by couplingthe modulator to detectable substances including, but not limited to,various enzymes comprising for example horseradish peroxidase, alkalinephosphatase, beta-galactosidase, or acetylcholinesterase; prostheticgroups, such as but not limited to streptavidinlbiotin andavidin/biotin; fluorescent materials, such as but not limited to,umbelliferone, fluorescein, fluorescein isothiocynate, rhodamine,dichlorotriazinylamine fluorescein, dansyl chloride or phycoerythrin;luminescent materials, such as but not limited to, luminol;bioluminescent materials, such as but not limited to, luciferase,luciferin, and aequorin; radioactive materials, such as but not limitedto iodine (¹³¹I, ¹²⁵I, ¹²³I, ¹²¹I,), carbon (¹⁴C), sulfur (³⁵S), tritium(³H), indium (¹¹⁵In, ¹¹³In, ¹¹²In, ¹¹¹In), and technetium (⁹⁹Tc),thallium (²⁰¹Ti), gallium (⁶⁸Ga, ⁶⁷Ga), palladium (¹⁰³Pd), molybdenum(⁹⁹Mo), xenon (¹³³Xe), fluorine (¹⁸F), ¹⁵³Sm, ¹⁷⁷Lu, ¹⁵⁹Gd, ¹⁴⁹Pm,¹⁴⁰La, ¹⁷⁵Yb, ¹⁶⁶Ho, ⁹⁰Y, ⁴⁷Sc, ¹⁸⁶Re, ¹⁸⁸Re, ¹⁴²Pr, ¹⁰⁵Rh, ⁹⁷Ru, ⁶⁸Ge,⁵⁷Co, ⁶⁵Zn, ⁸⁵Sr, ³²P, ¹⁵³Gd, ¹⁶⁹Yb, ⁵¹Cr, ⁵⁴Mn, ⁷⁵Se, ¹¹³Sn, and¹¹⁷Tin; positron emitting metals using various positron emissiontomographies, noradioactive paramagnetic metal ions, and molecules thatare radiolabeled or conjugated to specific radioisotopes. In suchembodiments appropriate detection methodology is well known in the artand readily available from numerous commercial sources.

As indicated above, in other embodiments the modulators or fragmentsthereof can be fused or conjugated to marker sequences or compounds,such as a peptide or fluorophore to facilitate purification ordiagnostic or analytic procedures such as immunohistochemistry,bio-layer interferometry, surface plasmon resonance, flow cytometry,competitive ELISA, FACs, etc. In preferred embodiments, the markercomprises a his-tag such as that provided by the pQE vector (Qiagen),among others, many of which are commercially available. Other peptidetags useful for purification include, but are not limited to, thehemagglutinin “HA” tag, which corresponds to an epitope derived from theinfluenza hemagglutinin protein (Wilson et al., 1984, Cell 37:767) andthe “flag” tag (U.S. Pat. No. 4,703,004).

E. Therapeutic Moieties

As previously alluded to the modulators or fragments or derivativesthereof may also be conjugated, linked or fused to or otherwiseassociated with a″ therapeutic moiety” or “drug” such as ananti-proliferative or anti-cancer agent including, but not limited to,cytotoxic agents, cytostatic agents, anti-angiogenic agents, debulkingagents, chemotherapeutic agents, radiotherapy and radiotherapeuticagents, targeted anti-cancer agents, BRMs, therapeutic antibodies,cancer vaccines, cytokines, hormone therapies, radiation therapy andanti-metastatic agents and immunotherapeutic agents.

Preferred exemplary anti-cancer agents include cytochalasin B,gramicidin D, ethidium bromide, emetine, mitomycin, etoposide,tenoposide, vincristine, vinblastine, colchicin, doxorubicin,daunorubicin, dihydroxy anthracin, maytansinoids such as DM-1 and DM-4(Immunogen, Inc.), dione, mitoxantrone, mithramycin, actinomycin D,1-dehydrotestosterone, glucocorticoids, procaine, tetracaine, lidocaine,propranolol, puromycin, epirubicin, and cyclophosphamide and analogs orhomologs thereof. Additional compatible cytotoxins comprise dolastatinsand auristatins, including monomethyl auristatin E (MMAE) and monomethylauristatin F (MMAF) (Seattle Genetics, Inc.), amanitins such asalpha-amanitin, beta-amanitin, gamma-amanitin or epsilon-amanitin(Heidelberg Pharma AG), DNA minor groove binding agents such asduocarmycin derivatives (Syntarga, B.V.) and modifiedpyrrolobenzodiazepine dimers (Spirogen, Ltd.), splicing inhibitors suchas meayamycin analogs or derivatives (e.g., FR901464 as set forth inU.S. Pat. No. 7,825,267), tubular binding agents such as epothiloneanalogs and paclitaxel and DNA damaging agents such as calicheamicinsand esperamicins. Furthermore, in certain embodiments the SEZ6modulators of the instant invention may be associated with anti-CD3binding molecules to recruit cytotoxic T-cells and have them target thetumor initiating cells (BiTE technology; see e.g., Fuhrmann, S. et. al.Annual Meeting of AACR Abstract No. 5625 (2010) which is incorporatedherein by reference).

Still additional compatible anti-cancer agents include, but are notlimited to, antimetabolites (e.g., methotrexate, 6-mercaptopurine,6-thioguanine, cytarabine, 5-fluorouracil decarbazine), alkylatingagents (e.g., mechlorethamine, thioepa, chlorambucil, melphalan,carmustine (BCNU) and lomustine (CCNU), busulfan, dibromomannitol,streptozotocin, and cisdichlorodiamine platinum (II) (DDP) cisplatin),anthracyclines (e.g., daunorubicin (formerly daunomycin) anddoxorubicin), antibiotics (e.g., dactinomycin (formerly actinomycin),bleomycin, and anthramycin (AMC)), and anti-mitotic agents (e.g.,vincristine and vinblastine). A more extensive list of therapeuticmoieties can be found in PCT publication WO 03/075957 and U.S.P.N.2009/0155255 each of which is incorporated herein by reference.

As indicated above selected embodiments of the instant invention aredirected to conjugated SEZ6 modulators such as anti-SEZ6 antibody drugconjugates that comprise pyrrolobenzodiazepine (PBD) as a cytotoxicagent. It will be appreciated that PBDs are alkylating agents that exertanti-tumor activity by covalently binding to DNA in the minor groove andinhibiting nucleic acid synthesis. In this respect PBDs have been shownto have potent antitumor properties while exhibiting minimal bone marrowdepression. PBDs compatible with the present invention may be linked tothe SEZ6 modulator using any one of several types of linker (e.g., apeptidyl linker comprising a maleimido moiety with a free sulfhydryl)and, in certain embodiments are dimeric in form (i.e., PBD dimers).Compatible PBDs (and optional linkers) that may be conjugated to thedisclosed modulators are described, for example, in U.S. Pat. Nos.6,362,331, 7,049,311, 7,189,710, 7,429,658, 7,407,951, 7,741,319,7,557,099, 8,034,808, 8,163,736 U.S.P.N. 2011/0256157 and PCT filingsWO2011/130613, WO2011/128650 and WO2011/130616 each of which isincorporated herein by reference. Accordingly, in particularly preferredembodiments the modulator will comprise an anti SEZ6 antibody conjugatedor associated with one or more PBD dimers (i.e., a SEZ6-PBD ADC).

In particularly preferred embodiments compatible PBDs that may beconjugated to the disclosed modulators are described in U.S.P.N.2011/0256157. In this disclosure, PBD dimers, i.e. those comprising twoPBD moieties may be preferred. Thus, preferred conjugates of the presentinvention are those having the formula (AB) or (AC):

wherein:

the dotted lines indicate the optional presence of a double bond betweenC1 and C2 or C2 and C3;

R² is independently selected from H, OH, ═O, ═CH₂, CN, R, OR, ═CH—R^(D),═C(R^(D))₂, O—SO₂—R, CO₂R and COR, and optionally further selected fromhalo or dihalo;

where R^(D) is independently selected from R, CO₂R, COR, CHO, CO₂H, andhalo;

R⁶ and R⁹ are independently selected from H, R, OH, OR, SH, SR, NH₂,NHR, NRR′, NO₂, Me₃Sn and halo;

R⁷ is independently selected from H, R, OH, OR, SH, SR, NH₂, NHR, NRR′,NO₂, Me₃ Sn and halo;

R¹⁰ is a linker connected to a modulator or fragment or derivativethereof, as described above;

Q is independently selected from O, S and NH;

R¹¹ is either H, or R or, where Q is O, SO₃M, where M is a metal cation;

R and R′ are each independently selected from optionally substitutedC₁₋₁₂ alkyl, C₃₋₂₀ heterocyclyl and C₅₋₂₀ aryl groups, and optionally inrelation to the group NRR′, R and R′ together with the nitrogen atom towhich they are attached form an optionally substituted 4-, 5-, 6- or7-membered heterocyclic ring; and

wherein R^(2″), R^(6″), R^(7″), R^(9″), X″, Q″ and R^(11″) and are asdefined according to R², R⁶, R⁷, R⁹, X, Q and R¹¹ respectively, andR^(C) is a capping group.

Double Bond

In one embodiment, there is no double bond present between C1 and C2,and C2 and C3.

In one embodiment, the dotted lines indicate the optional presence of adouble bond between C2 and C3, as shown below:

In one embodiment, a double bond is present between C2 and C3 when R² isC₅₋₂₀ aryl or C₁₋₁₂ alkyl.

In one embodiment, the dotted lines indicate the optional presence of adouble bond between C1 and C2, as shown below:

In one embodiment, a double bond is present between C1 and C2 when R² isC₅₋₂₀ aryl or C₁₋₁₂ alkyl.

R²

In one embodiment, R² is independently selected from H, OH, ═O, ═CH₂,CN, R, OR, ═CH—R^(D), ═C(R^(D))₂, O—SO₂—R, CO₂R and COR, and optionallyfurther selected from halo or dihalo.

In one embodiment, R² is independently selected from H, OH, ═O, ═CH₂,CN, R, OR, ═CH—R^(D), ═C(R^(D))₂, O—SO₂—R, CO₂R and COR.

In one embodiment, R² is independently selected from H, ═O, ═CH₂, R,═CH—R^(D), and ═C(R^(D))₂.

In one embodiment, R² is independently H.

In one embodiment, R² is independently ═O.

In one embodiment, R² is independently ═CH₂.

In one embodiment, R² is independently ═CH—R^(D). Within the PBDcompound, the group ═CH—R^(D) may have either configuration shown below:

In one embodiment, the configuration is configuration (I).

In one embodiment, R² is independently ═C(R^(D))₂.

In one embodiment, R² is independently ═CF₂.

In one embodiment, R² is independently R.

In one embodiment, R² is independently optionally substituted C₅₋₂₀aryl.

In one embodiment, R² is independently optionally substituted C₁₋₁₂alkyl.

In one embodiment, R² is independently optionally substituted C₅₋₂₀aryl.

In one embodiment, R² is independently optionally substituted C₅₋₇ aryl.

In one embodiment, R² is independently optionally substituted C₈₋₁₀aryl.

In one embodiment, R² is independently optionally substituted phenyl.

In one embodiment, R² is independently optionally substituted napthyl.

In one embodiment, R² is independently optionally substituted pyridyl.

In one embodiment, R² is independently optionally substituted quinolinylor isoquinolinyl.

In one embodiment, R² bears one to three substituent groups, with 1 and2 being more preferred, and singly substituted groups being mostpreferred. The substituents may be any position.

Where R² is a C₅₋₇ aryl group, a single substituent is preferably on aring atom that is not adjacent the bond to the remainder of thecompound, i.e. it is preferably β or γ to the bond to the remainder ofthe compound. Therefore, where the C₅₋₇ aryl group is phenyl, thesubstituent is preferably in the meta- or para-positions, and morepreferably is in the para-position.

In one embodiment, R² is selected from:

where the asterisk indicates the point of attachment.

Where R² is a C₈₋₁₀ aryl group, for example quinolinyl or isoquinolinyl,it may bear any number of substituents at any position of the quinolineor isoquinoline rings. In some embodiments, it bears one, two or threesubstituents, and these may be on either the proximal and distal ringsor both (if more than one substituent).

In one embodiment, where R² is optionally substituted, the substituentsare selected from those substituents given in the substituent sectionbelow.

Where R is optionally substituted, the substituents are preferablyselected from:

Halo, Hydroxyl, Ether, Formyl, Acyl, Carboxy, Ester, Acyloxy, Amino,Amido, Acylamido, Aminocarbonyloxy, Ureido, Nitro, Cyano and Thioether.

In one embodiment, where R or R² is optionally substituted, thesubstituents are selected from the group consisting of R, OR, SR, NRR′,NO₂, halo, CO₂R, COR, CONH₂, CONHR, and CONRR′.

Where R² is C₁₋₁₂ alkyl, the optional substituent may additionallyinclude C₃₋₂₀ heterocyclyl and C₅₋₂₀ aryl groups.

Where R² is C₃₋₂₀ heterocyclyl, the optional substituent mayadditionally include C₁₋₁₂ alkyl and C₅₋₂₀ aryl groups.

Where R² is C₅₋₂₀ aryl groups, the optional substituent may additionallyinclude C₃₋₂₀ heterocyclyl and C₁₋₁₂ alkyl groups.

It is understood that the term “alkyl” encompasses the sub-classesalkenyl and alkynyl as well as cycloalkyl. Thus, where R² is optionallysubstituted C₁₋₁₂ alkyl, it is understood that the alkyl groupoptionally contains one or more carbon-carbon double or triple bonds,which may form part of a conjugated system. In one embodiment, theoptionally substituted C₁₋₁₂ alkyl group contains at least onecarbon-carbon double or triple bond, and this bond is conjugated with adouble bond present between C1 and C2, or C2 and C3. In one embodiment,the C₁₋₁₂ alkyl group is a group selected from saturated C₁₋₁₂ alkyl,C₂₋₁₂ alkenyl, C₂₋₁₂ alkynyl and C₃₋₁₂ cycloalkyl.

If a substituent on R² is halo, it is preferably F or Cl, morepreferably Cl.

If a substituent on R² is ether, it may in some embodiments be an alkoxygroup, for example, a C₁₋₇ alkoxy group (e.g. methoxy, ethoxy) or it mayin some embodiments be a C₅₋₇ aryloxy group (e.g phenoxy, pyridyloxy,furanyloxy).

If a substituent on R² is C₁₋₇ alkyl, it may preferably be a C₁₋₄ alkylgroup (e.g. methyl, ethyl, propyl, butyl).

If a substituent on R² is C₃₋₇ heterocyclyl, it may in some embodimentsbe C₆ nitrogen containing heterocyclyl group, e.g. morpholino,thiomorpholino, piperidinyl, piperazinyl. These groups may be bound tothe rest of the PBD moiety via the nitrogen atom. These groups may befurther substituted, for example, by C₁₋₄ alkyl groups.

If a substituent on R² is bis-oxy-C₁₋₃ alkylene, this is preferablybis-oxy-methylene or bis-oxy-ethylene.

Particularly preferred substituents for R² include methoxy, ethoxy,fluoro, chloro, cyano, bis-oxy-methylene, methyl-piperazinyl, morpholinoand methyl-thienyl.

Particularly preferred substituted R² groups include, but are notlimited to, 4-methoxyphenyl, 3-methoxyphenyl, 4-ethoxy-phenyl,3-ethoxy-phenyl, 4-fluoro-phenyl, 4-chlorophenyl,3,4-bisoxymethylene-phenyl, 4-methylthienyl, 4-cyanophenyl,4-phenoxyphenyl, quinolin-3-yl and quinolin-6-yl, isoquinolin-3-yl andisoquinolin-6-yl, 2-thienyl, 2-furanyl, methoxynaphthyl, and naphthyl.

In one embodiment, R² is halo or dihalo. In one embodiment, R² is —F or—F₂, which substituents are illustrated below as (III) and (IV)respectively:

R^(D)

In one embodiment, R^(D) is independently selected from R, CO₂R, COR,CHO, CO₂H, and halo.

In one embodiment, R^(D) is independently R.

In one embodiment, R^(D) is independently halo.

R⁶

In one embodiment, R⁶ is independently selected from H, R, OH, OR, SH,SR, NH₂, NHR, NRR′, NO₂, Me₃ Sn— and Halo.

In one embodiment, R⁶ is independently selected from H, OH, OR, SH, NH₂,NO₂ and Halo.

In one embodiment, R⁶ is independently selected from H and Halo.

In one embodiment, R⁶ is independently H.

In one embodiment, R⁶ and R⁷ together form a group —O—(CH₂)_(p)—O—,where p is 1 or 2.

R⁷

R⁷ is independently selected from H, R, OH, OR, SH, SR, NH₂, NHR, NRR′,NO₂, Me₃Sn and halo.

In one embodiment, R⁷ is independently OR.

In one embodiment, R⁷ is independently OR^(7A), where R^(7A) isindependently optionally substituted C₁₋₆ alkyl.

In one embodiment, R^(7A) is independently optionally substitutedsaturated C₁₋₆ alkyl.

In one embodiment, R^(7A) is independently optionally substituted C₂₋₄alkenyl.

In one embodiment, R^(7A) is independently Me.

In one embodiment, R^(7A) is independently CH₂Ph.

In one embodiment, R^(7A) is independently allyl.

In one embodiment, the compound is a dimer where the R⁷ groups of eachmonomer form together a dimer bridge having the formula X—R″—X linkingthe monomers.

R⁸

In one embodiment, the compound is a dimer where the R⁸ groups of eachmonomer form together a dimer bridge having the formula X—R″—X linkingthe monomers.

In one embodiment, R⁸ is independently OR^(8A), where R^(8A) isindependently optionally substituted C₁₋₄ alkyl.

In one embodiment, R^(8A) is independently optionally substitutedsaturated C₁₋₆ alkyl or optionally substituted C₂₋₄ alkenyl.

In one embodiment, R^(8A) is independently Me.

In one embodiment, R^(8A) is independently CH₂Ph.

In one embodiment, R^(8A) is independently allyl.

In one embodiment, R⁸ and R⁷ together form a group —O—(CH₂)_(p)—O—,where p is 1 or 2.

In one embodiment, R⁸ and R⁹ together form a group —O—(CH₂)_(p)—O—,where p is 1 or 2.

R⁹

In one embodiment, R⁹ is independently selected from H, R, OH, OR, SH,SR, NH₂, NHR, NRR′, NO₂, Me₃ Sn— and Halo.

In one embodiment, R⁹ is independently H.

In one embodiment, R⁹ is independently R or OR.

R and R′

In one embodiment, R is independently selected from optionallysubstituted C₁₋₁₂ alkyl, C₃₋₂₀ heterocyclyl and C₅₋₂₀ aryl groups. Thesegroups are each defined in the substituents section below.

In one embodiment, R is independently optionally substituted C₁₋₁₂alkyl.

In one embodiment, R is independently optionally substituted C₃₋₂₀heterocyclyl.

In one embodiment, R is independently optionally substituted C₅₋₂₀ aryl.

In one embodiment, R is independently optionally substituted C₁₋₁₂alkyl.

Described above in relation to R² are various embodiments relating topreferred alkyl and aryl groups and the identity and number of optionalsubstituents. The preferences set out for R² as it applies to R areapplicable, where appropriate, to all other groups R, for examples whereR⁶, R⁷, R⁸ or R⁹ is R.

The preferences for R apply also to R′.

In some embodiments of the invention there is provided a compound havinga substituent group —NRR′. In one embodiment, R and R′ together with thenitrogen atom to which they are attached form an optionally substituted4-, 5-, 6- or 7-membered heterocyclic ring. The ring may contain afurther heteroatom, for example N, O or S.

In one embodiment, the heterocyclic ring is itself substituted with agroup R. Where a further N heteroatom is present, the substituent may beon the N heteroatom.

R″

R″ is a C₃₋₁₂ alkylene group, which chain may be interrupted by one ormore heteroatoms, e.g. O, S, N(H), NMe and/or aromatic rings, e.g.benzene or pyridine, which rings are optionally substituted.

In one embodiment, R″ is a C₃₋₁₂ alkylene group, which chain may beinterrupted by one or more heteroatoms and/or aromatic rings, e.g.benzene or pyridine.

In one embodiment, the alkylene group is optionally interrupted by oneor more heteroatoms selected from O, S, and NMe and/or aromatic rings,which rings are optionally substituted.

In one embodiment, the aromatic ring is a C₅₋₂₀ arylene group, wherearylene pertains to a divalent moiety obtained by removing two hydrogenatoms from two aromatic ring atoms of an aromatic compound, which moietyhas from 5 to 20 ring atoms.

In one embodiment, R″ is a C₃₋₁₂ alkylene group, which chain may beinterrupted by one or more heteroatoms, e.g. O, S, N(H), NMe and/oraromatic rings, e.g. benzene or pyridine, which rings are optionallysubstituted by NH₂.

In one embodiment, R″ is a C₃₋₁₂ alkylene group.

In one embodiment, R″ is selected from a C₃, C₅, C₇, C₉ and a C₁₁alkylene group.

In one embodiment, R″ is selected from a C₃, C₅ and a C₇ alkylene group.

In one embodiment, R″ is selected from a C₃ and a C₅ alkylene group.

In one embodiment, R″ is a C₃ alkylene group.

In one embodiment, R″ is a C₅ alkylene group.

The alkylene groups listed above may be optionally interrupted by one ormore heteroatoms and/or aromatic rings, e.g. benzene or pyridine, whichrings are optionally substituted.

The alkylene groups listed above may be optionally interrupted by one ormore heteroatoms and/or aromatic rings, e.g. benzene or pyridine.

The alkylene groups listed above may be unsubstituted linear aliphaticalkylene groups.

X

In one embodiment, X is selected from O, S, or N(H).

Preferably, X is O.

R¹⁰

Preferably compatible linkers such as those described above attach aSEZ6 modulator (CBA/Ab/M), to a PBD drug moiety D through covalentbond(s) at the R¹⁰ position (i.e., N10). The linker is a bifunctional ormultifunctional moiety which can be used to link one or more drug moiety(D) and a modulator (preferably an antibody) to form antibody-drugconjugates (ADC). The linker (L) may be stable outside a cell, i.e.extracellular, or it may be cleavable by enzymatic activity, hydrolysis,or other metabolic conditions. Antibody-drug conjugates (ADC) can beconveniently prepared using a linker having reactive functionality forbinding to the drug moiety and to the antibody. A cysteine thiol, or anamine, e.g. N-terminus or amino acid side chain such as lysine, of theantibody (Ab) can form a bond with a functional group of a linker orspacer reagent, PBD drug moiety (D) or drug-linker reagent (D-L).

Many functional groups on the linker attached to the N10 position of thePBD moiety may be useful to react with the cell binding agent. Forexample, ester, thioester, amide, thioamide, carbamate, thiocarbamate,urea, thiourea, ether, thioether, or disulfide linkages may be formedfrom reaction of the linker-PBD drug intermediates and the cell bindingagent.

In another embodiment, the linker may be substituted with groups thatmodulate aggregation, solubility or reactivity. For example, a sulfonatesubstituent may increase water solubility of the reagent and facilitatethe coupling reaction of the linker reagent with the antibody or thedrug moiety, or facilitate the coupling reaction of Ab-L with D, or D-Lwith Ab, depending on the synthetic route employed to prepare the ADC.

In one preferred embodiment, R¹⁰ is a group:

where the asterisk indicates the point of attachment to the N10position, CBA is a cell binding agent/modulator, L¹ is a linker, A is aconnecting group connecting L¹ to the cell binding agent, L² is acovalent bond or together with —OC(═O)— forms a self-immolative linker,and L¹ or L² is a cleavable linker.

L¹ is preferably the cleavable linker, and may be referred to as atrigger for activation of the linker for cleavage.

As discussed in the linker section above the nature of L¹ and L², wherepresent, can vary widely. These groups are chosen on the basis of theircleavage characteristics, which may be dictated by the conditions at thesite to which the conjugate is delivered. Those linkers that are cleavedby the action of enzymes are preferred, although linkers that arecleavable by changes in pH (e.g. acid or base labile), temperature orupon irradiation (e.g. photolabile) may also be used. Linkers that arecleavable under reducing or oxidizing conditions may also find use inthe present invention.

L¹ may comprise a contiguous sequence of amino acids. The amino acidsequence may be the target substrate for enzymatic cleavage, therebyallowing release of R¹⁰ from the N10 position.

In one embodiment, L¹ is cleavable by the action of an enzyme. In oneembodiment, the enzyme is an esterase or a peptidase.

In one embodiment, L² is present and together with —C(═O)O— forms aself-immolative linker. In one embodiment, L² is a substrate forenzymatic activity, thereby allowing release of R¹⁰ from the N10position.

In one embodiment, where L¹ is cleavable by the action of an enzyme andL² is present, the enzyme cleaves the bond between L¹ and L².

With regard to attaching the chosen linker to a selected PBD the groupR^(C) is removable from the N10 position of certain PBD moieties toleave an N10-C11 imine bond, a carbinolamine, a substitutedcarbinolamine, where QR¹¹ is OSO₃M, a bisulfite adduct, athiocarbinolamine, a substituted thiocarbinolamine, or a substitutedcarbinalamine.

In one embodiment, R^(C), may be a protecting group that is removable toleave an N10-C11 imine bond, a carbinolamine, a substitutedcabinolamine, or, where QR¹¹ is OSO₃M, a bisulfite adduct. In oneembodiment, R^(C) is a protecting group that is removable to leave anN10-C11 imine bond.

The group R^(C) is intended to be removable under the same conditions asthose required for the removal of the group R¹⁰, for example to yield anN10-C11 imine bond, a carbinolamine and so on. The capping group acts asa protecting group for the intended functionality at the N10 position.The capping group is intended not to be reactive towards a cell bindingagent. For example, R^(C) is not the same as R^(L).

Compounds having a capping group may be used as intermediates in thesynthesis of dimers having an imine monomer. Alternatively, compoundshaving a capping group may be used as conjugates, where the cappinggroup is removed at the target location to yield an imine, acarbinolamine, a substituted cabinolamine and so on. Thus, in thisembodiment, the capping group may be referred to as a therapeuticallyremovable nitrogen protecting group, as defined in WO 00/12507.

In one embodiment, the group R^(C) is removable under the conditionsthat cleave the linker R^(L) of the group R¹⁰. Thus, in one embodiment,the capping group is cleavable by the action of an enzyme.

In an alternative embodiment, the capping group is removable prior tothe connection of the linker R^(L) to the modulator. In this embodiment,the capping group is removable under conditions that do not cleave thelinker R^(L).

Where a compound includes a functional group G¹ to form a connection tothe cell binding agent, the capping group is removable prior to theaddition or unmasking of G¹.

The capping group may be used as part of a protecting group strategy toensure that only one of the monomer units in a dimer is connected to acell binding agent.

The capping group may be used as a mask for a N10-C11 imine bond. Thecapping group may be removed at such time as the imine functionality isrequired in the compound. The capping group is also a mask for acarbinolamine, a substituted cabinolamine, and a bisulfite adduct, asdescribed above.

In one embodiment, R^(C) is a carbamate protecting group.

In one embodiment, the carbamate protecting group is selected from:

Alloc, Fmoc, Boc, Troc, Teoc, Psec, Cbz and PNZ.

Optionally, the carbamate protecting group is further selected from Moc.

In one embodiment, R^(C) is a linker group R^(L) lacking the functionalgroup for connection to the cell binding agent.

This application is particularly concerned with those R^(C) groups whichare carbamates.

In one embodiment, R^(C) is a group:

where the asterisk indicates the point of attachment to the N10position, G² is a terminating group, L³ is a covalent bond or acleavable linker L¹, L² is a covalent bond or together with OC(═O) formsa self-immolative linker.

Where L³ and L² are both covalent bonds, G² and OC(═O) together form acarbamate protecting group as defined above.

L¹ is as defined above in relation to R¹⁰.

L² is as defined above in relation to R¹⁰.

Various terminating groups are described below, including those based onwell known protecting groups.

In one embodiment L³ is a cleavable linker L¹, and L², together withOC(═O), forms a self-immolative linker. In this embodiment, G² is Ac(acetyl) or Moc, or a carbamate protecting group selected from: Alloc,Fmoc, Boc, Troc, Teoc, Psec, Cbz and PNZ. Optionally, the carbamateprotecting group is further selected from Moc.

In another embodiment, G² is an acyl group —C(═O)G³, where G³ isselected from alkyl (including cycloalkyl, alkenyl and alkynyl),heteroalkyl, heterocyclyl and aryl (including heteroaryl and carboaryl).These groups may be optionally substituted. The acyl group together withan amino group of L³ or L², where appropriate, may form an amide bond.The acyl group together with a hydroxy group of L³ or L², whereappropriate, may form an ester bond.

In one embodiment, G³ is heteroalkyl. The heteroalkyl group may comprisepolyethylene glycol. The heteroalkyl group may have a heteroatom, suchas O or N, adjacent to the acyl group, thereby forming a carbamate orcarbonate group, where appropriate, with a heteroatom present in thegroup L³ or L², where appropriate.

In one embodiment, G³ is selected from NH₂, NHR and NRR′. Preferably, G³is NRR′.

In one embodiment G² is the group:

where the asterisk indicates the point of attachment to L³, n is 0 to 6and G⁴ is selected from OH, OR, SH, SR, COOR, CONH₂, CONHR, CONRR′, NH₂,NHR, NRR′, NO₂, and halo. The groups OH, SH, NH₂ and NHR are protected.In one embodiment, n is 1 to 6, and preferably n is 5. In oneembodiment, G⁴ is OR, SR, COOR, CONH₂, CONHR, CONRR′, and NRR′. In oneembodiment, G⁴ is OR, SR, and NRR′. Preferably G⁴ is selected from ORand NRR′, most preferably G⁴ is OR. Most preferably G⁴ is OMe.

In one embodiment, the group G² is:

where the asterisk indicates the point of attachment to L³, and n and G⁴are as defined above.

In one embodiment, the group G² is:

where the asterisk indicates the point of attachment to L³, n is 0 or 1,m is 0 to 50, and G⁴ is selected from OH, OR, SH, SR, COOR, CONH₂,CONHR, CONRR′, NH₂, NHR, NRR′, NO₂, and halo. In a preferred embodiment,n is 1 and m is 0 to 10, 1 to 2, preferably 4 to 8, and most preferably4 or 8. In another embodiment, n is 1 and m is 10 to 50, preferably 20to 40. The groups OH, SH, NH₂ and NHR are protected. In one embodiment,G⁴ is OR, SR, COOR, CONH₂, CONHR, CONRR′, and NRR′. In one embodiment,G⁴ is OR, SR, and NRR′. Preferably G⁴ is selected from OR and NRR′, mostpreferably G⁴ is OR. Preferably G⁴ is OMe.

In one embodiment, the group G² is:

where the asterisk indicates the point of attachment to L³, and n, m andG⁴ are as defined above.

In one embodiment, the group G² is:

where n is 1-20, m is 0-6, and G⁴ is selected from OH, OR, SH, SR, COOR,CONH₂, CONHR, CONRR′, NH₂, NHR, NRR′, NO₂, and halo. In one embodiment,n is 1-10. In another embodiment, n is 10 to 50, preferably 20 to 40. Inone embodiment, n is 1. In one embodiment, m is 1. The groups OH, SH,NH₂ and NHR are protected. In one embodiment, G⁴ is OR, SR, COOR, CONH₂,CONHR, CONRR′, and NRR′. In one embodiment, G⁴ is OR, SR, and NRR′.Preferably G⁴ is selected from OR and NRR′, most preferably G⁴ is OR.Preferably G⁴ is OMe.

In one embodiment, the group G² is:

where the asterisk indicates the point of attachment to L³, and n, m andG⁴ are as defined above.

In each of the embodiments above G⁴ may be OH, SH, NH₂ and NHR. Thesegroups are preferably protected.

In one embodiment, OH is protected with Bzl, TBDMS, or TBDPS.

In one embodiment, SH is protected with Acm, Bzl, Bzl-OMe, Bzl-Me, orTrt.

In one embodiment, NH₂ or NHR are protected with Boc, Moc, Z—Cl, Fmoc,Z, or Alloc.

In one embodiment, the group G² is present in combination with a groupL³, which group is a dipeptide.

The capping group is not intended for connection to the modulator. Thus,the other monomer present in the dimer serves as the point of connectionto the modulator via a linker. Accordingly, it is preferred that thefunctionality present in the capping group is not available for reactionwith a modulator. Thus, reactive functional groups such as OH, SH, NH₂,COOH are preferably avoided. However, such functionality may be presentin the capping group if protected, as described above.

Thus, in accordance with the teachings herein one embodiment of theinvention comprises a conjugate comprising a compound:

wherein CBA is a cell binding agent/modulator, and n is 0 or 1. L¹ is aspreviously defined, and R^(E) and R^(E)″ are each independently selectedfrom H or R^(D).

In another embodiment, the conjugate comprises a compound:

wherein CBA is a cell binding agent/modulator, L¹ is as previouslydefined, Ar¹ and Ar² are each independently optionally substituted C₅₋₂₀aryl, and n is 0 or 1.

Those of skill in the art will appreciate that other symmetric andasymmetric PBD dimers and linkers are compatible with the instantinvention and could be selected without undue experimentation based onthe teachings herein and the prior art.

Another aspect of the invention includes ADCs comprising radioisotopes.Exemplary radioisotopes that may be compatible with such embodimentsinclude, but are not limited to, iodine (¹³¹I, ¹²⁵I, ¹²³I, ¹²¹I,),carbon (¹⁴C), copper (⁶²Cu, ⁶⁴Cu, ⁶⁷Cu), sulfur (³⁵S), tritium (³H),indium (¹¹⁵In, ¹¹³In, ¹¹²In, ¹¹¹In,), bismuth (²¹²Bi, ²¹³Bi), technetium(⁹⁹Tc), thallium (²⁰¹Ti), gallium (⁶⁸Ga, ⁶⁷Ga), palladium (¹⁰³Pd),molybdenum (⁹⁹Mo), xenon (¹³³Xe), fluorine (¹⁸F), ¹⁵³Sm, ¹⁷⁷Lu, ¹⁵⁹Gd,¹⁴⁹Pm, ¹⁴⁰La, ¹⁷⁵Yb, ¹⁶⁶Ho, ⁹⁰Y, ⁴⁷Sc, ¹⁸⁶Re, ¹⁸⁸Re, ¹⁴²Pr, ¹⁰⁵Rh, ⁹⁷Ru,⁶⁸Ge, ⁵⁷Co, ⁶⁵Zn, ⁸⁵Sr, ³²P, ¹⁵³Gd, ¹⁶⁹Yb, ⁵¹Cr, ⁵⁴Mn, ⁷⁵Se, ¹¹³Sn,¹¹⁷Sn, ²²⁵Ac, ⁷⁶Br, and ²¹¹At. Other radionuclides are also available asdiagnostic and therapeutic agents, especially those in the energy rangeof 60 to 4,000 keV. Depending on the condition to be treated and thedesired therapeutic profile, those skilled in the art may readily selectthe appropriate radioisotope for use with the disclosed modulators.

SEZ6 modulators of the present invention may also be conjugated to atherapeutic moiety or drug that modifies a given biological response(e.g., biological response modifiers or BRMs). That is, therapeuticagents or moieties compatible with the instant invention are not to beconstrued as limited to classical chemical therapeutic agents. Forexample, in particularly preferred embodiments the drug moiety may be aprotein or polypeptide or fragment thereof possessing a desiredbiological activity. Such proteins may include, for example, a toxinsuch as abrin, ricin A, Onconase (or another cytotoxic RNase),pseudomonas exotoxin, cholera toxin, or diphtheria toxin; a protein suchas tumor necrosis factor, α-interferon, β-interferon, nerve growthfactor, platelet derived growth factor, tissue plasminogen activator, anapoptotic agent, e.g., TNF-α, TNF-β, AIM I (see, InternationalPublication No. WO 97/33899), AIM II (see, International Publication No.WO 97/34911), Fas Ligand (Takahashi et al., 1994, J. Immunol., 6:1567),and VEGI (see, International Publication No. WO 99/23105), a thromboticagent or an anti-angiogenic agent, e.g., angiostatin or endostatin; or,a biological response modifier such as, for example, a lymphokine (e.g.,interleukin-1 (“IL-1”), interleukin-2 (“IL-2”), interleukin-6 (“IL-6”),granulocyte macrophage colony stimulating factor (“GM-CSF”), andgranulocyte colony stimulating factor (“G-CSF”)), or a growth factor(e.g., growth hormone (“GH”)). As set forth above, methods for fusing orconjugating modulators to polypeptide moieties are known in the art. Inaddition to the previously disclosed subject references see, e.g., U.S.Pat. Nos. 5,336,603; 5,622,929; 5,359,046; 5,349,053; 5,447,851, and5,112,946; EP 307,434; EP 367,166; PCT Publications WO 96/04388 and WO91/06570; Ashkenazi et al., 1991, PNAS USA 88:10535; Zheng et al., 1995,J Immunol 154:5590; and Vil et al., 1992, PNAS USA 89:11337 each ofwhich is incorporated herein by reference. Moreover, as set forth abovethe association of a modulator with such moieties does not necessarilyneed to be direct, but may occur through linker sequences. As previouslyalluded to, such linker molecules are commonly known in the art anddescribed in Denardo et al., 1998, Clin Cancer Res 4:2483; Peterson etal., 1999, Bioconjug Chem 10:553; Zimmerman et al., 1999, Nucl Med Biol26:943; Garnett, 2002, Adv Drug Deliv Rev 53:171 each of which isincorporated herein.

IX. Diagnostics and Screening

A. Diagnostics

In yet other embodiments, the invention provides in vitro or in vivomethods for detecting, diagnosing or monitoring proliferative disordersand methods of screening cells from a patient to identify tumorigeniccells including CSCs. Such methods include identifying an individualhaving cancer for treatment or monitoring progression of a cancercomprising contacting the patient or a sample obtained from a patient(i.e. either in vivo or in vitro) with a modulator as described hereinand detecting presence or absence, or level of association, of themodulator to bound or free target molecules in the sample. Inparticularly preferred embodiments the modulator will comprise adetectable label or reporter molecule as described herein.

In some embodiments, the association of the modulator, such as anantibody, with particular cells in the sample likely denotes that thesample may contain CSCs, thereby indicating that the individual havingcancer may be effectively treated with a modulator as described herein.The methods may further comprise a step of comparing the level ofbinding to a control. Conversely, when the modulator is a Fc-construct,the binding properties may be exploited and monitored (directly orindirectly, in vivo or in vitro) when in contact with the sample toprovide the desired information.

Exemplary compatible assay methods include radioimmunoassays, enzymeimmunoassays, competitive-binding assays, fluorescent immunoassay,immunoblot assays, Western Blot analysis, flow cytometry assays, andELISA assays. Compatible in vivo theragnostics or diagnostics maycomprise art-recognized imaging or monitoring techniques such asmagnetic resonance imaging, computerized tomography (e.g. CAT scan),positron tomography (e.g., PET scan) radiography, ultrasound, etc., aswould be known by those skilled in the art.

In another embodiment, the invention provides a method of analyzingcancer progression and/or pathogenesis in vivo. In another embodiment,analysis of cancer progression and/or pathogenesis in vivo comprisesdetermining the extent of tumor progression. In another embodiment,analysis comprises the identification of the tumor. In anotherembodiment, analysis of tumor progression is performed on the primarytumor. In another embodiment, analysis is performed over time dependingon the type of cancer as known to one skilled in the art. In anotherembodiment, further analysis of secondary tumors originating frommetastasizing cells of the primary tumor is analyzed in-vivo. In anotherembodiment, the size and shape of secondary tumors are analyzed. In someembodiments, further ex vivo analysis is performed.

In another embodiment, the invention provides a method of analyzingcancer progression and/or pathogenesis in vivo including determiningcell metastasis or detecting and quantifying the level of circulatingtumor cells. In yet another embodiment, analysis of cell metastasiscomprises determination of progressive growth of cells at a site that isdiscontinuous from the primary tumor. In another embodiment, the site ofcell metastasis analysis comprises the route of neoplastic spread. Insome embodiment, cells can disperse via blood vasculature, lymphatics,within body cavities or combinations thereof. In another embodiment,cell metastasis analysis is performed in view of cell migration,dissemination, extravasation, proliferation or combinations thereof.

Accordingly, in a particularly preferred embodiment the modulators ofthe instant invention may be used to detect and quantify SEZ6 levels ina patient sample (e.g., plasma or blood) which may, in turn, be used todetect, diagnose or monitor SEZ6 associated disorders includingproliferative disorders. In related embodiments the modulators of theinstant invention may be used to detect, monitor and/or quantifycirculating tumor cells either in vivo or in vitro (see, for example, WO2012/0128801 which is incorporated herein by reference). In still otherpreferred embodiments the circulating tumor cells may comprise cancerstem cells.

In certain examples, the tumorigenic cells in a subject or a sample froma subject may be assessed or characterized using the disclosedmodulators prior to therapy or regimen to establish a baseline. In otherexamples the sample is derived from a subject that was treated. In someexamples the sample is taken from the subject at least about 1, 2, 4, 6,7, 8, 10, 12, 14, 15, 16, 18, 20, 30, 60, 90 days, 6 months, 9 months,12 months, or >12 months after the subject begins or terminatestreatment. In certain examples, the tumorigenic cells are assessed orcharacterized after a certain number of doses (e.g., after 2, 5, 10, 20,30 or more doses of a therapy). In other examples, the tumorigenic cellsare characterized or assessed after 1 week, 2 weeks, 1 month, 2 months,1 year, 2 years, 3 years, 4 years or more after receiving one or moretherapies.

In another aspect, and as discussed in more detail below, the presentinvention provides kits for detecting, monitoring or diagnosing ahyperproliferative disorder, identifying individual having such adisorder for possible treatment or monitoring progression (orregression) of the disorder in a patient, wherein the kit comprises amodulator as described herein, and reagents for detecting the impact ofthe modulator on a sample.

Yet another aspect of the instant invention comprises the use of labeledSEZ6 for immunohistochemistry (IHC). In this respect SEZ6 IHC may beused as a diagnostic tool to aid in the diagnosis of variousproliferative disorders and to monitor the potential response totreatments including SEZ6 modulator therapy. Compatible diagnosticassays may be performed on tissues that have been chemically fixed(including but not limited to: formaldehyde, gluteraldehyde, osmiumtetroxide, potassium dichromate, acetic acid, alcohols, zinc salts,mercuric chloride, chromium tetroxide and picric acid) and embedded(including but not limited to: glycol methacrylate, paraffin and resins)or preserved via freezing. As discussed in more detail below such assayscould be used to guide treatment decisions and determine dosing regimensand timing.

In a preferred embodiment the invention is directed to a method ofdiagnosing platinum resistant small cell lung cancer comprising thesteps of: (a) providing a small cell lung cancer tumor sample from asubject; (b) exposing the tumor sample to an anti-SEZ6 antibody labeledwith a reporter wherein said anti-SEZ6 antibody associates with thetumor sample; and (c) detecting the reporter associated with the tumorsample. In a preferred embodiment such reporter may be detected using anin vitro diagnostic method (e.g.IHC, in situ hybridization or flowcytometry). In some embodiments, the step of providing the tumor samplemay be performed separately from the step of exposing the tumor sampleto an anti-SEZ6 antibody or the step of detecting the reporterassociated with the tumor sample.

In another embodiment the invention is directed to a method ofdiagnosing medullary thyroid cancer comprising the steps of: (a)providing a medullary thyroid tumor sample from a subject; (b) exposingthe tumor sample to an anti-SEZ6 antibody labeled with a reporterwherein said anti-SEZ6 antibody associates with the tumor sample; and(c) detecting the reporter associated with the tumor sample. In apreferred embodiment such reporter may be detected using an in vitrodiagnostic method (e.g.IHC, in situ hybridization or flow cytometry). Insome embodiments, the step of providing the tumor sample may beperformed separately from the step of exposing the tumor sample to ananti-SEZ6 antibody or the step of detecting the reporter associated withthe tumor sample.

B. Screening

In certain embodiments, the modulators can also be used to screen for oridentify compounds or agents (e.g., drugs) that alter a function oractivity of tumorigenic cells or progeny thereof by interacting with anantigen (e.g., genotypic or phenotypic components thereof). Suchcompounds and agents can be drug candidates that are screened for thetreatment of a proliferative disorder, for example. In one embodiment, asystem or method includes tumorigenic cells comprising SEZ6 and acompound or agent (e.g., drug), wherein the cells and compound or agentare in contact with each other. In such embodiments the subject cellsmay have been identified, monitored and/or enriched using the disclosedmodulators.

In yet another embodiment, a method includes contacting, directly orindirectly, tumorigenic cells or progeny thereof with a test agent orcompound and determining if the test agent or compound modulates anactivity or function of the antigen-associated tumorigenic cells. Oneexample of a direct interaction is physical interaction, while anindirect interaction includes the action of a composition upon anintermediary molecule that, in turn, acts upon the referenced entity(e.g., cell or cell culture). Exemplary activities or functions that canbe modulated include changes in cell morphology or viability, expressionof a marker, differentiation or de-differentiation, cell respiration,mitochondrial activity, membrane integrity, maturation, proliferation,viability, apoptosis or cell death.

Methods of screening and identifying agents and compounds include thosesuitable for high throughput screening, which include arrays of cells(e.g., microarrays) positioned or placed, optionally at pre-determinedlocations or addresses. For example, cells can be positioned or placed(pre-seeded) on a culture dish, tube, flask, roller bottle or plate(e.g., a single multi-well plate or dish such as an 8, 16, 32, 64, 96,384 and 1536 multi-well plate or dish). High-throughput robotic ormanual handling methods can probe chemical interactions and determinelevels of expression of many genes in a short period of time. Techniqueshave been developed that utilize molecular signals (e.g., viafluorophores) and automated analyses that process information at a veryrapid rate (see, e.g., Pinhasov et al., Comb. Chem. High ThroughputScreen. 7:133 (2004)). For example, microarray technology has beenextensively used to probe the interactions of thousands of genes atonce, while providing information for specific genes (see, e.g.,Mocellin and Rossi, Adv. Exp. Med. Biol. 593:19 (2007)).

Libraries that can be screened include, for example, small moleculelibraries, phage display libraries, fully human antibody yeast displaylibraries (Adimab, LLC), siRNA libraries, and adenoviral transfectionvectors.

X. Pharmaceutical Preparations and Therapeutic Uses

A. Formulations and Routes of Administration

Depending on the form of the modulator along with any optionalconjugate, the mode of intended delivery, the disease being treated ormonitored and numerous other variables, compositions of the inventionmay be formulated as desired using art-recognized techniques. In someembodiments, the therapeutic compositions of the invention may beadministered neat or with a minimum of additional components whileothers may optionally be formulated to contain suitable pharmaceuticallyacceptable carriers comprising excipients and auxiliaries that are wellknown in the art (see, e.g., Gennaro, Remington: The Science andPractice of Pharmacy with Facts and Comparisons: Drugfacts Plus, 20thed. (2003); Ansel et al., Pharmaceutical Dosage Forms and Drug DeliverySystems, 7^(th) ed., Lippencott Williams and Wilkins (2004); Kibbe etal., Handbook of Pharmaceutical Excipients, 3^(rd) ed., PharmaceuticalPress (2000)). Various pharmaceutically acceptable carriers, whichinclude vehicles, adjuvants, and diluents, are readily available fromnumerous commercial sources. Moreover, an assortment of pharmaceuticallyacceptable auxiliary substances, such as pH adjusting and bufferingagents, tonicity adjusting agents, stabilizers, wetting agents and thelike, are also available. Certain non-limiting exemplary carriersinclude saline, buffered saline, dextrose, water, glycerol, ethanol, andcombinations thereof.

More particularly it will be appreciated that, in some embodiments, thetherapeutic compositions of the invention may be administered neat orwith a minimum of additional components. Conversely the SEZ6 modulatorsof the present invention may optionally be formulated to containsuitable pharmaceutically acceptable carriers comprising excipients andauxiliaries that are well known in the art and are relatively inertsubstances that facilitate administration of the modulator or which aidprocessing of the active compounds into preparations that arepharmaceutically optimized for delivery to the site of action. Forexample, an excipient can give form or consistency or act as a diluentto improve the pharmacokinetics or stability of the modulator. Suitableexcipients or additives include, but are not limited to, stabilizingagents, wetting and emulsifying agents, salts for varying osmolarity,encapsulating agents, buffers, and skin penetration enhancers. Incertain preferred embodiments the pharmaceutical compositions may beprovided in a lyophilized form and reconstituted in, for example,buffered saline prior to administration.

Disclosed modulators for systemic administration may be formulated forenteral, parenteral or topical administration. Indeed, all three typesof formulation may be used simultaneously to achieve systemicadministration of the active ingredient. Excipients as well asformulations for parenteral and nonparenteral drug delivery are setforth in Remington, The Science and Practice of Pharmacy 20th Ed. MackPublishing (2000). Suitable formulations for parenteral administrationinclude aqueous solutions of the active compounds in water-soluble form,for example, water-soluble salts. In addition, suspensions of the activecompounds as appropriate for oily injection suspensions may beadministered. Suitable lipophilic solvents or vehicles include fattyoils, for example, hexylsubstituted poly(lactide), sesame oil, orsynthetic fatty acid esters, for example, ethyl oleate or triglycerides.Aqueous injection suspensions may contain substances that increase theviscosity of the suspension and include, for example, sodiumcarboxymethyl cellulose, sorbitol, and/or dextran. Optionally, thesuspension may also contain stabilizers. Liposomes can also be used toencapsulate the agent for delivery into the cell.

Suitable formulations for enteral administration include hard or softgelatin capsules, pills, tablets, including coated tablets, elixirs,suspensions, syrups or inhalations and controlled release forms thereof.

In general the compounds and compositions of the invention, comprisingSEZ6 modulators may be administered in vivo, to a subject in needthereof, by various routes, including, but not limited to, oral,intravenous, intra-arterial, subcutaneous, parenteral, intranasal,intramuscular, intracranial, intracardiac, intraventricular,intratracheal, buccal, rectal, intraperitoneal, intradermal, topical,transdermal, and intrathecal, or otherwise by implantation orinhalation. The subject compositions may be formulated into preparationsin solid, semi-solid, liquid, or gaseous forms; including, but notlimited to, tablets, capsules, powders, granules, ointments, solutions,suppositories, enemas, injections, inhalants, and aerosols. Theappropriate formulation and route of administration may be selectedaccording to the intended application and therapeutic regimen.

B. Dosages

Similarly, the particular dosage regimen, i.e., dose, timing andrepetition, will depend on the particular individual and thatindividual's medical history, as well as empirical considerations suchas pharmacokinetics (e.g., half-life, clearance rate, etc.). Frequencyof administration may be determined and adjusted over the course oftherapy, and is based on reducing the number of proliferative ortumorigenic cells, maintaining the reduction of such neoplastic cells,reducing the proliferation of neoplastic cells, or delaying thedevelopment of metastasis. In other embodiments the dosage administeredmay be adjusted or attenuated to manage potential side effects and/ortoxicity. Alternatively, sustained continuous release formulations of asubject therapeutic composition may be appropriate. In general, themodulators of the invention may be administered in various ranges.

These include about 10 μg/kg body weight to about 100 mg/kg body weightper dose; about 50 μg/kg body weight to about 5 mg/kg body weight perdose; about 100 μg/kg body weight to about 10 mg/kg body weight perdose. Other ranges include about 100 μg/kg body weight to about 20 mg/kgbody weight per dose and about 0.5 mg/kg body weight to about 20 mg/kgbody weight per dose. In certain embodiments, the dosage is at leastabout 100 μg/kg body weight, at least about 250 μg/kg body weight, atleast about 750 μg/kg body weight, at least about 3 mg/kg body weight,at least about 5 mg/kg body weight, at least about 10 mg/kg body weight.

In selected embodiments the modulators will be administered atapproximately 10, 20, 30, 40, 50, 60, 70, 80, 90 or 100 μg/kg bodyweight per dose. Other embodiments will comprise the administration ofmodulators at 200, 300, 400, 500, 600, 700, 800 or 900 μg/kg body weightper dose. In other preferred embodiments the disclosed modulators willbe administered at 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 mg/kg. In still otherembodiments the modulators may be administered at 12, 14, 16, 18 or 20mg/kg body weight per dose. In yet other embodiments the modulators maybe administered at 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 90 or100 mg/kg body weight per dose. In accordance with the teachings hereinit will be appreciated that the aforementioned dosages are applicable toboth unconjugated modulators and modulators conjugated to a cytotoxicagent. One of skill in the art could readily determine appropriatedosages for various conjugated and unconjugated modulators based onpreclinical animal studies, clinical observations and standard medicaland biochemical techniques and measurements.

With regard to conjugated modulators particularly preferred embodimentswill comprise dosages of between about 50 μg/kg to about 5 mg/kg bodyweight per dose. In this regard conjugated modulators may beadministered at 50, 75 or 100 μg/kg or at 0.2, 0.3, 0.4, 0.5, 0.6, 0.7,0.8, 0.9 or 1 mg/kg body weight per dose. In other preferred embodimentsthe conjugated modulators of the instant invention may be administeredat 1.25, 1.5, 1.75, 2, 2.25, 2.5, 2.75, 3, 3.25, 3.5, 3.75, 4, 4.25,4.5, 4.75 or 5 mg/kg body weight per dose. In particularly preferredembodiments such conjugated modulator dosages will be administeredintravenously over a period of time. Moreover, such dosages may beadministered multiple times over a defined course of treatment.

Other dosing regimens may be predicated on Body Surface Area (BSA)calculations as disclosed in U.S. Pat. No. 7,744,877. As is well known,the BSA is calculated using the patient's height and weight and providesa measure of a subject's size as represented by the surface area of hisor her body. In certain embodiments, the modulators may be administeredin dosages from 10 mg/m² to 800 mg/m², from 50 mg/m² to 500 mg/m² and atdosages of 100 mg/m², 150 mg/m², 200 mg/m², 250 mg/m², 300 mg/m², 350mg/m², 400 mg/m² or 450 mg/m².

It will also be appreciated that art recognized and empirical techniquesmay be used to determine appropriate dosage for conjugated modulators(i.e., ADCs).

In any event, SEZ6 modulators (both conjugated and unconjugated) arepreferably administered as needed to subjects in need thereof.Determination of the frequency of administration may be made by personsskilled in the art, such as an attending physician based onconsiderations of the condition being treated, age of the subject beingtreated, severity of the condition being treated, general state ofhealth of the subject being treated and the like. Generally, aneffective dose of the SEZ6 modulator is administered to a subject one ormore times. More particularly, an effective dose of the modulator isadministered to the subject once a month, more than once a month, orless than once a month. In certain embodiments, the effective dose ofthe SEZ6 modulator may be administered multiple times, including forperiods of at least a month, at least six months, at least a year, atleast two years or a period of several years. In yet other embodiments,several days (2, 3, 4, 5, 6 or 7), several weeks (1, 2, 3, 4, 5, 6, 7 or8) or several months (1, 2, 3, 4, 5, 6, 7 or 8) or even a year orseveral years may lapse between administration of the disclosedmodulators.

In certain preferred embodiments the course of treatment involvingconjugated modulators will comprise multiple doses of the selected drugproduct (i.e., an ADC) over a period of weeks or months. Morespecifically, conjugated modulators of the instant invention mayadministered once every day, every two days, every four days, everyweek, every ten days, every two weeks, every three weeks, every month,every six weeks, every two months, every ten weeks or every threemonths. In this regard it will be appreciated that the dosages may bealtered or the interval may be adjusted based on patient response andclinical practices.

Dosages and regimens may also be determined empirically for thedisclosed therapeutic compositions in individuals who have been givenone or more administration(s). For example, individuals may be givenincremental dosages of a therapeutic composition produced as describedherein. In selected embodiments the dosage may be gradually increased orreduced or attenuated based respectively on empirically determined orobserved side effects or toxicity. To assess efficacy of the selectedcomposition, a marker of the specific disease, disorder or condition canbe followed as described previously. In embodiments where the individualhas cancer, these include direct measurements of tumor size viapalpation or visual observation, indirect measurement of tumor size byx-ray or other imaging techniques; an improvement as assessed by directtumor biopsy and microscopic examination of the tumor sample; themeasurement of an indirect tumor marker (e.g., PSA for prostate cancer)or an antigen identified according to the methods described herein, adecrease in pain or paralysis; improved speech, vision, breathing orother disability associated with the tumor; increased appetite; or anincrease in quality of life as measured by accepted tests orprolongation of survival. It will be apparent to one of skill in the artthat the dosage will vary depending on the individual, the type ofneoplastic condition, the stage of neoplastic condition, whether theneoplastic condition has begun to metastasize to other location in theindividual, and the past and concurrent treatments being used.

C. Combination Therapies

Combination therapies may be particularly useful in decreasing orinhibiting unwanted neoplastic cell proliferation, decreasing theoccurrence of cancer, decreasing or preventing the recurrence of cancer,or decreasing or preventing the spread or metastasis of cancer. In suchcases the modulators of the instant invention may function assensitizing or chemosensitizing agents by removing the CSCs that wouldotherwise prop up and perpetuate the tumor mass and thereby allow formore effective use of current standard of care debulking or anti-canceragents. “Combination therapy”, as used herein, means the administrationof a combination comprising at least one SEZ6 modulator and at least onetherapeutic moiety (e.g., anti-cancer agent) wherein the combinationpreferably has therapeutic synergy or improves the measurabletherapeutic effects in the treatment of cancer (e.g. medullary thyroidcancer or SCLC) over (i) the SEZ6 modulator used alone, or (ii) thetherapeutic moiety used alone, or (iii) the use of the therapeuticmoiety in combination with another therapeutic moiety without theaddition of a SEZ6 modulator. The term “therapeutic synergy”, as usedherein, means the combination of a SEZ6 modulator and one or moretherapeutic moiety(ies) having a therapeutic effect greater than theadditive effect of the combination of the SEZ6 modulator and the one ormore therapeutic moiety(ies).

In the context of “combination therapy” in the instant invention, thetherapeutic moiety may include one or more anti-cancer agents thatinclude, but are not limited to, cytotoxic agents, cytostatic agents,anti-angiogenic agents, debulking agents, chemotherapeutic agents,radiotherapy and radiotherapeutic agents, targeted anti-cancer agents(including both monoclonal antibodies and small molecule entities),BRMs, therapeutic antibodies, cancer vaccines, cytokines, hormonetherapies, radiation therapy and anti-metastatic agents andimmunotherapeutic agents, including both specific and non-specificapproaches.

Desired outcomes of the disclosed combinations are quantified bycomparison to a control or baseline measurement. As used herein,relative terms such as “improve,” “increase,” or “reduce” indicatevalues relative to a control, such as a measurement in the sameindividual prior to initiation of treatment described herein, or ameasurement in a control individual (or multiple control individuals) inthe absence of the SEZ6 modulator described herein but in the presenceof other therapeutic moiety(ies) such as standard of care treatment. Arepresentative control individual is an individual afflicted with thesame form of cancer as the individual being treated, who is about thesame age as the individual being treated (to ensure that the stages ofthe disease in the treated individual and the control individual arecomparable.)

Changes or improvements in response to therapy are generallystatistically significant. As used herein, the term “significance” or“significant” relates to a statistical analysis of the probability thatthere is a non-random association between two or more entities. Todetermine whether or not a relationship is “significant” or has“significance,” a “p-value” can be calculated. P-values that fall belowa user-defined cut-off point are regarded as significant. A p-value lessthan or equal to 0.1, less than 0.05, less than 0.01, less than 0.005,or less than 0.001 may be regarded as significant.

A synergistic therapeutic effect may be an effect of at least abouttwo-fold greater than the therapeutic effect elicited by a singletherapeutic moiety or SEZ6 modulator, or the sum of the therapeuticeffects elicited by the SEZ6 modulator or the single therapeuticmoiety(ies) of a given combination, or at least about five-fold greater,or at least about ten-fold greater, or at least about twenty-foldgreater, or at least about fifty-fold greater, or at least about onehundred-fold greater. A synergistic therapeutic effect may also beobserved as an increase in therapeutic effect of at least 10% comparedto the therapeutic effect elicited by a single therapeutic moiety orSEZ6 modulator, or the sum of the therapeutic effects elicited by theSEZ6 modulator or the single therapeutic moiety(ies) of a givencombination, or at least 20%, or at least 30%, or at least 40%, or atleast 50%, or at least 60%, or at least 70%, or at least 80%, or atleast 90%, or at least 100%, or more. A synergistic effect is also aneffect that permits reduced dosing of therapeutic agents when they areused in combination.

In practicing combination therapy, the modulator and anti-cancer agentmay be administered to the subject simultaneously, either in a singlecomposition, or as two or more distinct compositions using the same ordifferent administration routes. Alternatively, the modulator mayprecede, or follow, the anti-cancer agent treatment by, e.g., intervalsranging from minutes to weeks. The time period between each delivery issuch that the anti-cancer agent and modulator are able to exert acombined effect on the tumor. In at least one embodiment, both theanti-cancer agent and the modulator are administered within about 5minutes to about two weeks of each other. In yet other embodiments,several days (2, 3, 4, 5, 6 or 7), several weeks (1, 2, 3, 4, 5, 6, 7 or8) or several months (1, 2, 3, 4, 5, 6, 7 or 8) may lapse betweenadministration of the modulator and the anti-cancer agent.

The combination therapy may be administered once, twice or at least fora period of time until the condition is treated, palliated or cured. Insome embodiments, the combination therapy is administered multipletimes, for example, from three times daily to once every six months. Theadministering may be on a schedule such as three times daily, twicedaily, once daily, once every two days, once every three days, onceweekly, once every two weeks, once every month, once every two months,once every three months, once every six months or may be administeredcontinuously via a minipump. The combination therapy may be administeredvia any route, as noted previously. The combination therapy may beadministered at a site distant from the site of the tumor.

In one embodiment a modulator is administered in combination with one ormore anti-cancer agents for a short treatment cycle to a subject in needthereof. The invention also contemplates discontinuous administration ordaily doses divided into several partial administrations. The modulatorand anti-cancer agent may be administered interchangeably, on alternatedays or weeks; or a sequence of antibody treatments may be given,followed by one or more treatments of anti-cancer agent therapy. In anyevent, as will be understood by those of ordinary skill in the art, theappropriate doses of chemotherapeutic agents will be generally aroundthose already employed in clinical therapies wherein thechemotherapeutics are administered alone or in combination with otherchemotherapeutics.

In another preferred embodiment the SEZ6 modulators of the instantinvention may be used in maintenance therapy to reduce or eliminate thechance of tumor recurrence following the initial presentation of thedisease. Preferably the disorder will have been treated and the initialtumor mass eliminated, reduced or otherwise ameliorated so the patientis asymptomatic or in remission. At such time the subject may beadministered pharmaceutically effective amounts of the disclosedmodulators one or more times even though there is little or noindication of disease using standard diagnostic procedures. In someembodiments, the modulators will be administered on a regular scheduleover a period of time, such as weekly, every two weeks, monthly, everysix weeks, every two months, every three months every six months orannually. Given the teachings herein, one skilled in the art couldreadily determine favorable dosages and dosing regimens to reduce thepotential of disease recurrence. Moreover such treatments could becontinued for a period of weeks, months, years or even indefinitelydepending on the patient response and clinical and diagnosticparameters.

In yet another preferred embodiment the modulators of the presentinvention may be used to prophylactically or as an adjuvant therapy toprevent or reduce the possibility of tumor metastasis following adebulking procedure. As used in the instant disclosure a “debulkingprocedure” is defined broadly and shall mean any procedure, technique ormethod that eliminates, reduces, treats or ameliorates a tumor or tumorproliferation. Exemplary debulking procedures include, but are notlimited to, surgery, radiation treatments (i.e., beam radiation),chemotherapy, immunotherapy or ablation. At appropriate times readilydetermined by one skilled in the art in view of the instant disclosurethe disclosed modulators may be administered as suggested by clinical,diagnostic or theragnostic procedures to reduce tumor metastasis. Themodulators may be administered one or more times at pharmaceuticallyeffective dosages as determined using standard techniques. Preferablythe dosing regimen will be accompanied by appropriate diagnostic ormonitoring techniques that allow it to be modified.

Yet other embodiments of the invention comprise administering thedisclosed modulators to subjects that are asymptomatic but at risk ofdeveloping a proliferative disorder. That is, the modulators of theinstant invention may be used in a truly preventative sense and given topatients that have been examined or tested and have one or more notedrisk factors (e.g., genomic indications, family history, in vivo or invitro test results, etc.) but have not developed neoplasia. In suchcases those skilled in the art would be able to determine an effectivedosing regimen through empirical observation or through acceptedclinical practices.

In some embodiments the SEZ6 modulator may be used in combination withvarious first line SCLC treatments such platinum based agents (e.g.carboplatin, cisplatin and/or oxalaplatin). In one embodiment thecombination therapy comprises the use of a SEZ6 modulator and a platinumbased agent (e.g. carboplatin, cisplatin and/or oxalaplatin) andoptionally one or more other therapeutic moiety(ies). In anotherembodiment the SEZ6 modulator may be used in combination withcyclophosphamide and optionally doxorubicin and/or vincristine. In yetanother embodiment the SEZ6 modulator may be used in combination withetoposide. In further embodiments the SEZ6 modulator may be used incombination with topotecan or paclitaxel.

In other embodiments the SEZ6 modulator may be used in combination withvarious first line medullary thyroid treatments such cabozantinib orvandetanib. In one embodiment the combination therapy comprises the useof a SEZ6 modulator and cabozantinib and optionally one or more othertherapeutic moiety(ies). In another embodiment the combination therapycomprises the use of a SEZ6 modulator and vandetanib and optionally oneor more other therapeutic moiety(ies).

The combination therapy may comprise a SEZ6 modulator in combinationwith another therapeutic moiety that is effective on a medullary thyroidtumor comprising a mutated or aberrantly expressed gene or protein (e.g.RET).

The invention also provides for the combination of SEZ6 modulator withradiotherapy. In other embodiments a SEZ6 modulator may be used incombination with one or more of the anti-cancer described below.

D. Anti-Cancer Agents

The term “anti-cancer agent” or “anti-proliferative agent” means anyagent that can be used to treat a cell proliferative disorder such ascancer, and includes, but is not limited to, cytotoxic agents,cytostatic agents, anti-angiogenic agents, debulking agents,chemotherapeutic agents, radiotherapy and radiotherapeutic agents,targeted anti-cancer agents, BRMs, therapeutic antibodies, cancervaccines, cytokines, hormone therapies, radiation therapy andanti-metastatic agents and immunotherapeutic agents. It will beappreciated that, in selected embodiments as discussed above, suchanti-cancer agents may comprise conjugates and may be associated withmodulators prior to administration. In certain embodiments the disclosedanti-cancer agent will be linked to a SEZ6 modulator to provide an ADCas set forth herein.

As used herein the term “cytotoxic agent” means a substance that istoxic to the cells and decreases or inhibits the function of cellsand/or causes destruction of cells. Typically, the substance is anaturally occurring molecule derived from a living organism. Examples ofcytotoxic agents include, but are not limited to, small molecule toxinsor enzymatically active toxins of bacteria (e.g., Diptheria toxin,Pseudomonas endotoxin and exotoxin, Staphylococcal enterotoxin A),fungal (e.g., a-sarcin, restrictocin), plants (e.g., abrin, ricin,modeccin, viscumin, pokeweed anti-viral protein, saporin, gelonin,momoridin, trichosanthin, barley toxin, Aleurites fordii proteins,dianthin proteins, Phytolacca mericana proteins (PAPI, PAPII, andPAP-S), Momordica charantia inhibitor, curcin, crotin, saponariaofficinalis inhibitor, gelonin, mitegellin, restrictocin, phenomycin,neomycin, and the tricothecenes) or animals, (e.g., cytotoxic RNases,such as extracellular pancreatic RNases; DNase I, including fragmentsand/or variants thereof).

For the purposes of the instant invention a “chemotherapeutic agent”comprises a chemical compound that non-specifically decreases orinhibits the growth, proliferation, and/or survival of cancer cells(e.g., cytotoxic or cytostatic agents). Such chemical agents are oftendirected to intracellular processes necessary for cell growth ordivision, and are thus particularly effective against cancerous cells,which generally grow and divide rapidly. For example, vincristinedepolymerizes microtubules, and thus inhibits cells from enteringmitosis. In general, chemotherapeutic agents can include any chemicalagent that inhibits, or is designed to inhibit, a cancerous cell or acell likely to become cancerous or generate tumorigenic progeny (e.g.,TIC). Such agents are often administered, and are often most effective,in combination, e.g., in regimens such as CHOP or FOLFIRI. Again, inselected embodiments such chemotherapeutic agents may be conjugated tothe disclosed modulators.

Examples of anti-cancer agents that may be used in combination with (orconjugated to) the modulators of the present invention include, but arenot limited to, alkylating agents, alkyl sulfonates, aziridines,ethylenimines and methylamelamines, acetogenins, a camptothecin,bryostatin, callystatin, CC-1065, cryptophycins, dolastatin,duocarmycin, eleutherobin, pancratistatin, a sarcodictyin, spongistatin,nitrogen mustards, antibiotics, enediyne antibiotics, dynemicin,bisphosphonates, esperamicin, chromoprotein enediyne antiobioticchromophores, aclacinomysins, actinomycin, authramycin, azaserine,bleomycins, cactinomycin, carabicin, carminomycin, carzinophilin,chromomycinis, dactinomycin, daunorubicin, detorubicin,6-diazo-5-oxo-L-norleucine, ADRIAMYCIN® doxorubicin, epirubicin,esorubicin, idarubicin, marcellomycin, mitomycins, mycophenolic acid,nogalamycin, olivomycins, peplomycin, potfiromycin, puromycin,quelamycin, rodorubicin, streptonigrin, streptozocin, tubercidin,ubenimex, zinostatin, zorubicin; anti-metabolites, erlotinib,vemurafenib, crizotinib,sorafenib, ibrutinib, enzalutamide, folic acidanalogues, purine analogs, androgens, anti-adrenals, folic acidreplenisher such as frolinic acid, aceglatone, aldophosphamideglycoside, aminolevulinic acid, eniluracil, amsacrine, bestrabucil,bisantrene, edatraxate, defofamine, demecolcine, diaziquone,elfornithine, elliptinium acetate, an epothilone, etoglucid, galliumnitrate, hydroxyurea, lentinan, lonidainine, maytansinoids, mitoguazone,mitoxantrone, mopidanmol, nitraerine, pentostatin, phenamet,pirarubicin, losoxantrone, podophyllinic acid, 2-ethylhydrazide,procarbazine, PSK° polysaccharide complex (JHS Natural Products, Eugene,Oreg.), razoxane; rhizoxin; sizofiran; spirogermanium; tenuazonic acid;triaziquone; 2,2′,2″-trichlorotriethyl amine; trichothecenes (especiallyT-2 toxin, verracurin A, roridin A and anguidine); urethan; vindesine;dacarbazine; mannomustine; mitobronitol; mitolactol; pipobroman;gacytosine; arabinoside (“Ara-C”); cyclophosphamide; thiotepa; taxoids,chloranbucil; GEMZAR® gemcitabine; 6-thioguanine; mercaptopurine;methotrexate; platinum analogs, vinblastine; platinum; etoposide(VP-16); ifosfamide; mitoxantrone; vincristine; NAVELBINE® vinorelbine;novantrone; teniposide; edatrexate; daunomycin; aminopterin; xeloda;ibandronate; irinotecan (Camptosar, CPT-11), topoisomerase inhibitor RFS2000; difluorometlhylornithine; retinoids; capecitabine; combretastatin;leucovorin; oxaliplatin; inhibitors of PKC-alpha, Raf, H-Ras, EGFR andVEGF-A that reduce cell proliferation and pharmaceutically acceptablesalts, acids or derivatives of any of the above. Also included in thisdefinition are anti-hormonal agents that act to regulate or inhibithormone action on tumors such as anti-estrogens and selective estrogenreceptor modulators, aromatase inhibitors that inhibit the enzymearomatase, which regulates estrogen production in the adrenal glands,and anti-androgens; as well as troxacitabine (a 1,3-dioxolane nucleosidecytosine analog); antisense oligonucleotides, ribozymes such as a VEGFexpression inhibitor and a HER2 expression inhibitor; vaccines,PROLEUKIN® rIL-2; LURTOTECAN° topoisomerase 1 inhibitor; ABARELIX® rmRH;Vinorelbine and Esperamicins and pharmaceutically acceptable salts,acids or derivatives of any of the above.

In other embodiments the modulators of the instant invention may be usedin combination with any one of a number of antibodies (orimmunotherapeutic agents) presently in clinical trials or commerciallyavailable. To this end the disclosed modulators may be used incombination with an antibody selected from the group consisting ofabagovomab, adecatumumab, afutuzumab, alemtuzumab, altumomab,amatuximab, anatumomab, arcitumomab, bavituximab, bectumomab,bevacizumab, bivatuzumab, blinatumomab, brentuximab, cantuzumab,catumaxomab, cetuximab, citatuzumab, cixutumumab, clivatuzumab,conatumumab, daratumumab, drozitumab, duligotumab, dusigitumab,detumomab, dacetuzumab, dalotuzumab, ecromeximab, elotuzumab,ensituximab, ertumaxomab, etaracizumab, farletuzumab, ficlatuzumab,figitumumab, flanvotumab, futuximab, ganitumab, gemtuzumab,girentuximab, glembatumumab, ibritumomab, igovomab, imgatuzumab,indatuximab, inotuzumab, intetumumab, ipilimumab, iratumumab,labetuzumab, lexatumumab, lintuzumab, lorvotuzumab, lucatumumab,mapatumumab, matuzumab, milatuzumab, minretumomab, mitumomab,moxetumomab, narnatumab, naptumomab, necitumumab, nimotuzumab,nofetumomabn, ocaratuzumab, ofatumumab, olaratumab, onartuzumab,oportuzumab, oregovomab, panitumumab, parsatuzumab, patritumab,pemtumomab, pertuzumab, pintumomab, pritumumab, racotumomab, radretumab,rilotumumab, rituximab, robatumumab, satumomab, sibrotuzumab,siltuximab, simtuzumab, solitomab, tacatuzumab, taplitumomab,tenatumomab, teprotumumab, tigatuzumab, tositumomab, trastuzumab,tucotuzumab, ublituximab, veltuzumab, vorsetuzumab, votumumab,zalutumumab, CC49, 3F8 and combinations thereof.

Still other particularly preferred embodiments will comprise the use ofantibodies approved for cancer therapy including, but not limited to,rituximab, trastuzumab, gemtuzumab ozogamcin, alemtuzumab, ibritumomabtiuxetan, tositumomab, bevacizumab, cetuximab, panitumumab, ofatumumab,ipilimumab and brentuximab vedotin. Those skilled in the art will beable to readily identify additional anti-cancer agents that arecompatible with the teachings herein.

E. Radiotherapy

The present invention also provides for the combination of modulatorswith radiotherapy (i.e., any mechanism for inducing DNA damage locallywithin tumor cells such as gamma-irradiation, X-rays, UV-irradiation,microwaves, electronic emissions and the like). Combination therapyusing the directed delivery of radioisotopes to tumor cells is alsocontemplated, and may be used in connection with a targeted anti-canceragent or other targeting means. Typically, radiation therapy isadministered in pulses over a period of time from about 1 to about 2weeks. The radiation therapy may be administered to subjects having headand neck cancer for about 6 to 7 weeks. Optionally, the radiationtherapy may be administered as a single dose or as multiple, sequentialdoses.

XI. Indications

It will be appreciated that the modulators of the instant invention maybe used to diagnose, treat or inhibit the occurrence or recurrence ofany SEZ6 associated disorder. Accordingly, whether administered alone orin combination with an anti-cancer agent or radiotherapy, the modulatorsof the invention are particularly useful for generally treatingneoplastic conditions in patients or subjects which may include benignor malignant tumors (e.g., adrenal, liver, kidney, bladder, breast,gastric, ovarian, colorectal, prostate, pancreatic, lung, thyroid,hepatic, cervical, endometrial, esophageal and uterine carcinomas;sarcomas; glioblastomas; and various head and neck tumors); leukemiasand lymphoid malignancies; other disorders such as neuronal, glial,astrocytal, hypothalamic and other glandular, macrophagal, epithelial,stromal and blastocoelic disorders; and inflammatory, angiogenic,immunologic disorders and disorders caused by pathogens. Particularly,key targets for treatment are neoplastic conditions comprising solidtumors, although hematologic malignancies are within the scope of theinvention. Preferably the “subject” or “patient” to be treated will behuman although, as used herein, the terms are expressly held to compriseany mammalian species.

More specifically, neoplastic conditions subject to treatment inaccordance with the instant invention may be selected from the groupincluding, but not limited to, adrenal gland tumors, AIDS-associatedcancers, alveolar soft part sarcoma, astrocytic tumors, bladder cancer(squamous cell carcinoma and transitional cell carcinoma), bone cancer(adamantinoma, aneurismal bone cysts, osteochondroma, osteosarcoma),brain and spinal cord cancers, metastatic brain tumors, breast cancer,carotid body tumors, cervical cancer, chondrosarcoma, chordoma,chromophobe renal cell carcinoma, clear cell carcinoma, colon cancer,colorectal cancer, cutaneous benign fibrous histiocytomas, desmoplasticsmall round cell tumors, ependymomas, Ewing's tumors, extraskeletalmyxoid chondrosarcoma, fibrogenesis imperfecta ossium, fibrous dysplasiaof the bone, gallbladder and bile duct cancers, gestationaltrophoblastic disease, germ cell tumors, head and neck cancers, isletcell tumors, Kaposi's Sarcoma, kidney cancer (nephroblastoma, papillaryrenal cell carcinoma), leukemias, lipoma/benign lipomatous tumors,liposarcoma/malignant lipomatous tumors, liver cancer (hepatoblastoma,hepatocellular carcinoma), lymphomas, lung cancers (small cellcarcinoma, adenocarcinoma, squamous cell carcinoma, large cell carcinomaetc.), medulloblastoma, melanoma, meningiomas, multiple endocrineneoplasia, multiple myeloma, myelodysplastic syndrome, neuroblastoma,neuroendocrine tumors, ovarian cancer, pancreatic cancers, papillarythyroid carcinomas, parathyroid tumors, pediatric cancers, peripheralnerve sheath tumors, phaeochromocytoma, pituitary tumors, prostatecancer, posterious unveal melanoma, rare hematologic disorders, renalmetastatic cancer, rhabdoid tumor, rhabdomysarcoma, sarcomas, skincancer, soft-tissue sarcomas, squamous cell cancer, stomach cancer,synovial sarcoma, testicular cancer, thymic carcinoma, thymoma, thyroidmetastatic cancer, and uterine cancers (carcinoma of the cervix,endometrial carcinoma, and leiomyoma).

In certain preferred embodiments the proliferative disorder willcomprise a solid tumor including, but not limited to, adrenal, liver,kidney, bladder, breast, gastric, ovarian, cervical, uterine,esophageal, colorectal, prostate, pancreatic, lung (both small cell andnon-small cell), thyroid, carcinomas, sarcomas, glioblastomas andvarious head and neck tumors. In other preferred embodiments, and asshown in the Examples below, the disclosed modulators are especiallyeffective at treating small cell lung cancer (SCLC) and non-small celllung cancer (NSCLC) (e.g., squamous cell non-small cell lung cancer orsquamous cell small cell lung cancer).

In one embodiment, the small cell or non-small cell lung cancer isrefractory, relapsed or resistant to a taxane (e.g., docetaxel,paclitaxel, larotaxel or cabazitaxel) and/or a platinum based agent(e.g., carboplatin, cisplatin, oxaliplatin, topotecan, etc.). Withregards to platinum based agents, the primary standard-of-carechemotherapy for SCLC is combined cisplatin and etoposide. Following acourse of treatment, many patients become resistant to the platinumbased agent (Stewart, 2004; PMID: 20047843). There are multiplemechanisms of resistance to platinum-based drugs including changes tothe membrane composition, increased hypoxia, decreased expression ofcopper transporter genes, and increased expression of multidrugresistance genes, among other mechanisms. Given that most patients withSCLC will first be treated with the standard-of-care treatment, in someembodiments of the invention, the antibodies disclosed herein may beused to treat patients who have either failed to respond or relapsed.Initial platinum responsiveness is high but the majority of cancerpatients will eventually relapse with cisplatin-resistant disease. Inparticularly preferred embodiments the disclosed modulators may be usedin a conjugated form to treat small cell lung cancer. In other preferredembodiments the disclosed modulators may be used in a conjugated form totreat platinum resistant small cell lung cancer in a subject in needthereof. With regard to small cell lung cancer particularly preferredembodiments will comprise the administration of conjugated modulators(ADCs). In selected embodiments the conjugated modulators will beadministered to patients exhibiting limited stage disease. In otherembodiments the disclosed modulators will be administered to patientsexhibiting extensive stage disease. In other preferred embodiments thedisclosed conjugated modulators will be administered to refractorypatients (i.e., those who recur during or shortly after completing acourse of initial therapy). Still other embodiments comprise theadministration of the disclosed modulators to sensitive patients (i.e.,those whose relapse is longer than 2-3 months after primary therapy. Ineach case it will be appreciated that compatible modulators may be in aconjugated or unconjugated state depending the selected dosing regimenand the clinical diagnosis.

As discussed above the disclosed modulators may further be used toprevent, treat or diagnose tumors with neuroendocrine features orphenotypes including neuroendocrine tumors. True or canonicalneuroendocrine tumors (NETs) arising from the dispersed endocrine systemare relatively rare, with an incidence of 2-5 per 100,000 people, buthighly aggressive. Neuroendocrine tumors occur in the kidney,genitourinary tract (bladder, prostate, ovary, cervix, and endometrium),gastrointestinal tract (colon, stomach), thyroid (medullary thyroidcancer), and lung (small cell lung carcinoma and large cellneuroendocrine carcinoma). These tumors may secrete several hormonesincluding serotonin and/or chromogranin A that can cause debilitatingsymptoms known as carcinoid syndrome. Such tumors can be denoted bypositive immunohistochemical markers such as neuron-specific enolase(NSE, also known as gamma enolase, gene symbol=ENO2), CD56 (or NCAM1),chromogranin A (CHGA), and synaptophysin (SYP) or by genes known toexhibit elevated expression such as ASCL1. Unfortunately traditionalchemotherapies have not been particularly effective in treating NETs andliver metastasis is a common outcome.

In some embodiments of the invention, antibody drug conjugatescomprising an antibody conjugated directly or indirectly to atherapeutic moiety, wherein the antibody specifically binds to SEZ6, maybe used to treat a subject suffering from cancer (e.g. medullary thyroidcancer). In preferred embodiments the antibody drug conjugate used totreat cancer (e.g. medullary thyroid cancer) will comprise an anti-SEZ6antibody comprising a light chain variable region comprising three CDRsas set forth in FIG. 10A and a heavy chain variable region comprisingthree CDRs as set forth in FIG. 10B. In other embodiments the antibodydrug conjugate used to treat a subject suffering from cancer (e.g.medullary thyroid cancer) may compete with the anti-SEZ6 antibodiescomprising light and heavy chain variable regions set forth in FIGS. 10Aand 10B. In yet another embodiment, the antibody drug conjugates used totreat a a subject suffering from cancer (e.g. medullary thyroid cancer)may comprise a humanized anti-SEZ6 antibody, for example, hSC17.16,hSC17.17, hSC17.24, hSC17.28, hSC17.34, hSC17.46, hSC17.151, hSC17.155,hSC17.156, hSC17.161 and hSC17.200 as set out in FIGS. 10A and 10B andany antibodies that compete with such humanized antibodies. In otherembodiments of the invention, antibody drug conjugates comprising anantibody conjugated directly or indirectly to a therapeutic moiety,wherein the antibody specifically binds to SEZ6, may be used to treat asubject suffering from small cell lung cancer (e.g. platinum resistantsmall cell lung cancer). In preferred embodiments the antibody drugconjugate used to treat a subject suffering from small cell lung cancer(e.g. platinum resistant small cell lung cancer) may comprise ahumanized anti-SEZ6 antibody, for example, hSC17.16, hSC17.17, hSC17.24,hSC17.28, hSC17.34, hSC17.46, hSC17.151, hSC17.155, hSC17.156, hSC17.161and hSC17.200, as set out in FIGS. 10A and 10B and any antibodies thatcompete with such humanized antibodies. In preferred embodiments, thesubject suffering from small cell lung cancer will have previously beentreated with a platinum based agent.

While the disclosed modulators may be advantageously used to treatneuroendocrine tumors they may also be used to treat, prevent ordiagnose pseudo neuroendocrine tumors (pNETs) that genotypically orphenotypically mimic, resemble or exhibit common traits with canonicalneuroendocrine tumors. Pseudo neuroendocrine tumors or tumors withneuroendocrine features are tumors that arise from cells of the diffuseneuroendocrine system or from cells in which a neuroendocrinedifferentiation cascade has been aberrantly reactivated during theoncogenic process. Such pNETs commonly share certain phenotypic orbiochemical characteristics with traditionally defined neuroendocrinetumors, including the ability to produce subsets of biologically activeamines, neurotransmitters, and peptide hormones. Histologically, suchtumors (NETs and pNETs) share a common appearance often showing denselyconnected small cells with minimal cytoplasm of bland cytopathology andround to oval stippled nuclei. For the purposes of the instant inventioncommonly expressed histological markers or genetic markers that may beused to define neuroendocrine and pseudo neuroendocrine tumors include,but are not limited to, chromogranin A, CD56, synaptophysin, PGP9.5,ASCL1 and neuron-specific enolase (NSE).

Accordingly the modulators of the instant invention may beneficially beused to treat both pseudo neuroendocrine tumors and canonicalneuroendocrine tumors. In this regard the modulators may be used asdescribed herein to treat neuroendocrine tumors (both NET and pNET)arising in the kidney, genitourinary tract (bladder, prostate, ovary,cervix, and endometrium), gastrointestinal tract (colon, stomach),thyroid (medullary thyroid cancer), and lung (small cell lung carcinomaand large cell neuroendocrine carcinoma). Moreover, the modulators ofthe instant invention may be used to treat tumors expressing one or moremarkers selected from the group consisting of NSE, CD56, synaptophysin,chromogranin A, ASCL1 and PGP9.5 (UCHL1). That is, the present inventionmay be used to treat a subject suffering from a tumor that is NSE⁺ orCD56⁺ or PGP9.5⁺ or ASCL1⁺ or SYP⁺ or CHGA⁺ or some combination thereof.

With regard to hematologic malignancies it will be further beappreciated that the compounds and methods of the present invention maybe particularly effective in treating a variety of B-cell lymphomas,including low grade/NHL follicular cell lymphoma (FCC), mantle celllymphoma (MCL), diffuse large cell lymphoma (DLCL), small lymphocytic(SL) NHL, intermediate grade/follicular NHL, intermediate grade diffuseNHL, high grade immunoblastic NHL, high grade lymphoblastic NHL, highgrade small non-cleaved cell NHL, bulky disease NHL, Waldenstrom'sMacroglobulinemia, lymphoplasmacytoid lymphoma (LPL), mantle celllymphoma (MCL), follicular lymphoma (FL), diffuse large cell lymphoma(DLCL), Burkitt's lymphoma (BL), AIDS-related lymphomas, monocytic Bcell lymphoma, angioimmunoblastic lymphoadenopathy, small lymphocytic,follicular, diffuse large cell, diffuse small cleaved cell, large cellimmunoblastic lymphoblastoma, small, non-cleaved, Burkitt's andnon-Burkitt's, follicular, predominantly large cell; follicular,predominantly small cleaved cell; and follicular, mixed small cleavedand large cell lymphomas. See, Gaidono et al., “Lymphomas”, IN CANCER:PRINCIPLES & PRACTICE OF ONCOLOGY, Vol. 2: 2131-2145 (DeVita et al.,eds., 5.sup.th ed. 1997). It should be clear to those of skill in theart that these lymphomas will often have different names due to changingsystems of classification, and that patients having lymphomas classifiedunder different names may also benefit from the combined therapeuticregimens of the present invention.

The present invention also provides for a preventative or prophylactictreatment of subjects who present with benign or precancerous tumors.Beyond being a SEZ6 associated disorder it is not believed that anyparticular type of tumor or proliferative disorder should be excludedfrom treatment using the present invention. However, the type of tumorcells may be relevant to the use of the invention in combination withsecondary therapeutic agents, particularly chemotherapeutic agents andtargeted anti-cancer agents.

XII. Research Reagents

Other preferred embodiments of the invention also exploit the propertiesof the disclosed modulators as an instrument useful for identifying,monitoring, isolating, sectioning or enriching populations orsubpopulations of tumor initiating cells through methods such as flowcytometry, fluorescent activated cell sorting (FACS), magnetic activatedcell sorting (MACS) or laser mediated sectioning. Those skilled in theart will appreciate that the modulators may be used in severalcompatible techniques for the characterization and manipulation of TICincluding cancer stem cells (e.g., see U.S. Ser. Nos. 12/686,359,12/669,136 and 12/757,649 each of which is incorporated herein byreference in its entirety).

XIII. Articles of Manufacture

Pharmaceutical packs and kits comprising one or more containers,comprising one or more doses of a SEZ6 modulator are also provided. Incertain embodiments, a unit dosage is provided wherein the unit dosagecontains a predetermined amount of a composition comprising, forexample, an anti-SEZ6 antibody, with or without one or more additionalagents. For other embodiments, such a unit dosage is supplied insingle-use prefilled syringe for injection. In still other embodiments,the composition contained in the unit dosage may comprise saline,sucrose, or the like; a buffer, such as phosphate, or the like; and/orbe formulated within a stable and effective pH range. Alternatively, incertain embodiments, the composition may be provided as a lyophilizedpowder that may be reconstituted upon addition of an appropriate liquid,for example, sterile water. In certain preferred embodiments, thecomposition comprises one or more substances that inhibit proteinaggregation, including, but not limited to, sucrose and arginine. Anylabel on, or associated with, the container(s) indicates that theenclosed composition is used for diagnosing or treating the diseasecondition of choice.

The present invention also provides kits for producing single-dose ormulti-dose administration units of a SEZ6 modulator and, optionally, oneor more anti-cancer agents. The kit comprises a container and a label orpackage insert on or associated with the container. Suitable containersinclude, for example, bottles, vials, syringes, etc. The containers maybe formed from a variety of materials such as glass or plastic andcontain a pharmaceutically effective amount of the disclosed modulatorsin a conjugated or unconjugated form. In other preferred embodiments thecontainer(s) comprise a sterile access port (for example the containermay be an intravenous solution bag or a vial having a stopper pierceableby a hypodermic injection needle). Such kits will generally contain in asuitable container a pharmaceutically acceptable formulation of the SEZ6modulator and, optionally, one or more anti-cancer agents in the same ordifferent containers. The kits may also contain other pharmaceuticallyacceptable formulations, either for diagnosis or combined therapy. Forexample, in addition to the SEZ6 modulator of the invention such kitsmay contain any one or more of a range of anti-cancer agents such aschemotherapeutic or radiotherapeutic drugs; anti-angiogenic agents;anti-metastatic agents; targeted anti-cancer agents; cytotoxic agents;and/or other anti-cancer agents. Such kits may also provide appropriatereagents to conjugate the SEZ6 modulator with an anti-cancer agent ordiagnostic agent (e.g., see U.S. Pat. No. 7,422,739 which isincorporated herein by reference in its entirety).

More specifically the kits may have a single container that contains theSEZ6 modulator, with or without additional components, or they may havedistinct containers for each desired agent. Where combined therapeuticsare provided for conjugation, a single solution may be pre-mixed, eitherin a molar equivalent combination, or with one component in excess ofthe other. Alternatively, the SEZ6 modulator and any optionalanti-cancer agent of the kit may be maintained separately withindistinct containers prior to administration to a patient. The kits mayalso comprise a second/third container means for containing a sterile,pharmaceutically acceptable buffer or other diluent such asbacteriostatic water for injection (BWFI), phosphate-buffered saline(PBS), Ringer's solution and dextrose solution.

When the components of the kit are provided in one or more liquidsolutions, the liquid solution is preferably an aqueous solution, with asterile aqueous solution being particularly preferred. However, thecomponents of the kit may be provided as dried powder(s). When reagentsor components are provided as a dry powder, the powder can bereconstituted by the addition of a suitable solvent. It is envisionedthat the solvent may also be provided in another container.

As indicated briefly above the kits may also contain a means by which toadminister the antibody and any optional components to an animal orpatient, e.g., one or more needles or syringes, or even an eye dropper,pipette, or other such like apparatus, from which the formulation may beinjected or introduced into the animal or applied to a diseased area ofthe body. The kits of the present invention will also typically includea means for containing the vials, or such like, and other component inclose confinement for commercial sale, such as, e.g., injection orblow-molded plastic containers into which the desired vials and otherapparatus are placed and retained. Any label or package insert indicatesthat the SEZ6 modulator composition is used for treating cancer, forexample small cell lung cancer.

In other preferred embodiments the modulators of the instant inventionmay be used in conjunction with, or comprise, diagnostic or therapeuticdevices useful in the diagnosis or treatment of proliferative disorders.For example, in on preferred embodiment the compounds and compositionsof the instant invention may be combined with certain diagnostic devicesor instruments that may be used to detect, monitor, quantify or profilecells or marker compounds involved in the etiology or manifestation ofproliferative disorders. For selected embodiments the marker compoundsmay comprise NSE, CD56, synaptophysin, chromogranin A, and PGP9.5.

In particularly preferred embodiments the devices may be used to detect,monitor and/or quantify circulating tumor cells either in vivo or invitro (see, for example, WO 2012/0128801 which is incorporated herein byreference). In still other preferred embodiments, and as discussedabove, the circulating tumor cells may comprise cancer stem cells.

XIV. Miscellaneous

Unless otherwise defined herein, scientific and technical terms used inconnection with the present invention shall have the meanings that arecommonly understood by those of ordinary skill in the art. Further,unless otherwise required by context, singular terms shall includepluralities and plural terms shall include the singular. Morespecifically, as used in this specification and the appended claims, thesingular forms “a,” “an” and “the” include plural referents unless thecontext clearly dictates otherwise. Thus, for example, reference to “aprotein” includes a plurality of proteins; reference to “a cell”includes mixtures of cells, and the like. In addition, ranges providedin the specification and appended claims include both end points and allpoints between the end points. Therefore, a range of 2.0 to 3.0 includes2.0, 3.0, and all points between 2.0 and 3.0.

Generally, nomenclature used in connection with, and techniques of, celland tissue culture, molecular biology, immunology, microbiology,genetics and protein and nucleic acid chemistry and hybridizationdescribed herein are those well known and commonly used in the art. Themethods and techniques of the present invention are generally performedaccording to conventional methods well known in the art and as describedin various general and more specific references that are cited anddiscussed throughout the present specification unless otherwiseindicated. See, e.g., Abbas et al., Cellular and Molecular Immunology,6^(th) ed., W.B. Saunders Company (2010); Sambrook J. & Russell D.Molecular Cloning: A Laboratory Manual, 3rd ed., Cold Spring HarborLaboratory Press, Cold Spring Harbor, N.Y. (2000); Ausubel et al., ShortProtocols in Molecular Biology: A Compendium of Methods from CurrentProtocols in Molecular Biology, Wiley, John & Sons, Inc. (2002); Harlowand Lane Using Antibodies: A Laboratory Manual, Cold Spring HarborLaboratory Press, Cold Spring Harbor, N.Y. (1998); and Coligan et al.,Short Protocols in Protein Science, Wiley, John & Sons, Inc. (2003).Enzymatic reactions and purification techniques are performed accordingto manufacturer's specifications, as commonly accomplished in the art oras described herein. The nomenclature used in connection with, and thelaboratory procedures and techniques of, analytical chemistry, syntheticorganic chemistry, and medicinal and pharmaceutical chemistry describedherein are those well known and commonly used in the art. Moreover, anysection headings used herein are for organizational purposes only andare not to be construed as limiting the subject matter described.

XV. SEZ6 References

All references or documents disclosed or cited within this specificationare, without limitation, incorporated herein by reference in theirentirety. Moreover, any section headings used herein are fororganizational purposes only and are not to be construed as limiting thesubject matter described.

-   1. Bork P, Beckmann G. (1993). The CUB domain. A widespread module    in developmentally regulated proteins. J Mol Biol. 231:539-45. PMID:    8510165.-   2. 2. Cook M et al. (2010). Notch in the development of thryof    C-cells and the treatment of medullary thyroid cancer. Am J Transl    Res. 2:119-25. PMID:20182588-   3. Galluzzo P, and Bocchetta M (2011). Notch signaling in lung    cancer. Expert Rev Anticancer Ther. 11:533-40. PMID: 21504320.-   4. Gunnersen J M et al. (2007). Sez-6 proteins affect dendritic    arborization patterns and excitability of cortical pyramidal    neurons. Neuron. 56:621-39. PMID: 18031681.-   5. Gunnersen J M et al. (2009). Seizure-related gene 6 (Sez-6) in    amacrine cells of the rodent retina and the consequence of gene    deletion. PLoS One. 4:e6546. PMID: 19662096.-   6. Haddad R I (2013). How to incorporate new tyrosine kinase    inhibitors in the treatment of patients with medullary thyroid    cancer. J Clin Oncolo. 31:3618-20. PMID:24002516.-   7. Herbst R, Nicklin M J (1997). SEZ-6: promoter selectivity,    genomic structure and localized expression in the brain. Brain Res    Mol Brain Res. 44:309-22. PMID: 9073173.-   8. Klimstra D S, et al. (2010). The pathologic classification of    neuroendocrine tumors: a review of nomenclature, grading, and    staging systems. Pancreas. 39:707-12. PMID: 20664470.-   9. Klöppel G. (2011). Classification and pathology of    gastroenteropancreatic neuroendocrine neoplasms. Endocr Relat    Cancer. 18 Suppl 1:S1-16. PMID: 22005112.-   10. Mulley J C et al. (2011). The Role of Seizure-Related SEZ6 as a    Susceptibility Gene in Febrile Seizures. Neurol Res Int.    2011:917565. PMID: 21785725.-   11. Shimizu-Nishikawa K et al., (1995). Cloning and expression of    SEZ-6, a brain-specific and seizure-related cDNA. Brain Res Mol    Brain Res. 28:201-10. PMID: 7723619.-   12. Yao J C et al. (2008). One hundred years after “carcinoid”:    epidemiology of and prognostic factors for neuroendocrine tumors in    35,825 cases in the United States. J Clin Oncol. 26:3063-72. PMID:    18565894.-   13. Yu Z L et al., (2007). Febrile seizures are associated with    mutation of seizure-related (SEZ) 6, a brain-specific gene. J    Neurosci Res. 85:166-72. PMID: 17086543.

XVI. Sequence Listing Summary

Appended to the instant application is a sequence listing comprising anumber of nucleic acid and amino acid sequences. The following Table 2provides a summary of the included sequences.

TABLE 2 SEQ ID NO. Description 1 SEZ6 isoform 1 mRNA sequence 2 SEZ6isoform 2 mRNA sequence 3 SEZ6 isoform 1 protein sequence 4 SEZ6 isoform2 protein sequence 5 cDNA sequence of human SEZ6 ORF 6 Human SEZ6protein 7 cDNA sequence of a commercial SEZ6 clone (BC146292) 8 HumanSEZ6-Fc ORF 9 Human SEZ6-Fc protein 10 cDNA sequence of mouse SEZ6 ORF11 Mouse SEZ6 protein 12 cDNA sequence of rat SEZ6 ORF 13 Rat SEZ6protein 14 cDNA sequence of cynomolgus SEZ6 ORF 15 Cynomolgus SEZ6protein 16 cDNA sequence of human SEZ6L ECD 17 Human SEZ6L ECD protein18 cDNA sequence of human SEZ6L2 ECD 19 Human SEZ6L2 ECD protein 20SC17.1 VL protein 21 SC17.1 VH protein  22-169 Additional murine VL andVH proteins as in SEQ ID NOs 20-21 170 hSC17.16 VL protein 171 hSC17.16VH protein 172-199 Additional humanized VL and VH proteins as in SEQ IDNOs 170-171 200 Asn-Pro-Thr-Tyr (motif on the SEZ6 C-terminalcytoplasmic domain) 201 9-Histidine Tag 202-219 Reserve 220 SC17.1 VLnucleic acid 221 SC17.1 VH nucleic acid 222-369 Additional murine VL andVH nucleic acids as in SEQ ID NOs 220-221 370 hSC17.16 VL nucleic acid371 hSC17.16 VH nucleic acid 372-399 Additional humanized VL and VHnucleic acids as in SEQ ID NOs 270-271 400 hSC17.200 full length lightchain amino acid sequence 401 hSC17.200 full length heavy chain aminoacid sequence 402 hSC17.200vL1 full length light chain amino acidsequence 403 Kappa constant region protein 404 IgGI constant regionprotein 405, 406, 407 hSC17.16 CDRL1, CDRL2, CDRL3 408, 409, 410hSC17.16 CDRH1, CDRH2, CDRH3 411, 412, 413 hSC17.17 CDRL1, CDRL2, CDRL3414, 415, 416 hSC17.17 CDRH1, CDRH2, CDRH3 417, 418, 419 hSC17.24 CDRL1,CDRL2, CDRL3 420, 421, 422 hSC17.24 CDRH1, CDRH2, CDRH3 423, 424, 425hSC17.28 CDRL1, CDRL2, CDRL3 426, 427, 428 hSC17.28 CDRH1, CDRH2, CDRH3429, 430, 431 hSC17.34 CDRL1, CDRL2, CDRL3 432, 433, 434 hSC17.34 CDRH1,CDRH2, CDRH3 435, 436, 437 hSC17.46 CDRL1, CDRL2, CDRL3 438, 439, 440hSC17.46 CDRH1, CDRH2, CDRH3 441, 442, 443 hSC17.151 CDRL1, CDRL2, CDRL3444, 445, 446 hSC17.151 CDRH1, CDRH2, CDRH3 447, 448, 449 hSC17.155CDRL1, CDRL2, CDRL3 450, 451, 452 hSC17.155 CDRH1, CDRH2, CDRH3 453,454, 455 hSC17.156 CDRL1, CDRL2, CDRL3 456, 457, 458 hSC17.156 CDRH1,CDRH2, CDRH3 459, 460, 461 hSC17.161 CDRL1, CDRL2, CDRL3 462, 463, 464hSC17.161 CDRH1, CDRH2, CDRH3 465, 466, 467 hSC17.200 CDRL1, CDRL2,CDRL3 468, 469, 470 hSC17.200 CDRH1, CDRH2, CDRH3 471 hSC17.155vH1 FR1472 hSC17.155vH2 FR1 473 hSC17.155vH3 CDRH1 474 hSC17.155vH4 CDRH2 475hSC17.155vH5 CDRH2 476 hSC17.155vH6 CDRH2 477 hSC17.161vH1 FR1 478hSC17.161vH1 FR2 479 hSC17.161vH1 FR3 480 hSC17.200vL1 CDRL1

XVII. Selected Embodiments of the Invention

In addition to the disclosure herein, the present invention is directedto selected embodiments specifically set forth immediately below.

EXAMPLES

The present invention, thus generally described above, will beunderstood more readily by reference to the following examples, whichare provided by way of illustration and are not intended to be limitingof the instant invention. The examples are not intended to representthat the experiments below are all or the only experiments performed.Unless indicated otherwise, parts are parts by weight, molecular weightis weight average molecular weight, temperature is in degreesCentigrade, and pressure is at or near atmospheric.

Example 1 Identification of Tumors Having Neuroendocrine Features andAnalysis of Marker Expression Using Whole Transcriptome Sequencing

Neuroendocrine tumors (NETs) arising from the dispersed endocrine systemare rare, with an incidence of 2-5 per 100,000 people, but highlyaggressive. Neuroendocrine tumors occur in the adrenal gland, kidney,genitourinary tract (bladder, prostate, ovary, cervix, and endometrium),pancreas, gastrointestinal tract (stomach and colon), thyroid (medullarythyroid cancer), and lung (small cell lung carcinoma, large cellneuroendocrine carcinoma, and carcinoid). These tumors may secreteseveral hormones including serotonin and/or chromogranin A that cancause debilitating symptoms known as carcinoid syndrome. These tumorscan be denoted by positive immunohistochemical markers such asneuron-specific enolase (NSE, also known as gamma enolase, genesymbol=ENO2), CD56/NCAM1, and synaptophysin. Traditional chemotherapieshave not been successful in treating NETs, and mortality due tometastatic spread is a common outcome. Unfortunately, in most casessurgery is the only potential curative treatment, provided it takesplace following early detection and prior to tumor metastasis. In thiscontext work was undertaken to identify novel therapeutic targetsassociated with tumors comprising neuroendocrine features.

To identify and characterize such tumors as they exist in cancerpatients a large non-traditional xenograft (NTX) tumor bank wasdeveloped and maintained using art-recognized techniques. The NTX tumorbank, comprising a substantial number of discrete tumor cell lines, waspropagated in immunocompromised mice through multiple passages ofheterogeneous tumor cells originally obtained from numerous cancerpatients afflicted by a variety of solid tumor malignancies. (Note thatin some of the Examples and FIGS. herein the passage number of thetested sample is indicated by p0-p# appended to the sample designationwhere p0 is indicative of an unpassaged sample obtained directly from apatient tumor and p# is indicative of the number of times the tumor hasbeen passaged through a mouse prior to testing.) The continuedavailability of a large number of discrete early passage NTX tumor celllines having well defined lineages greatly facilitate the identificationand characterization of cells purified from the cell lines. In such workthe use of minimally passaged NTX cell lines simplifies in vivoexperimentation and provides readily verifiable results. Moreover, earlypassage NTX tumors respond to therapeutic agents such as irinotecan(i.e. Camptosar®) and Cisplatin/Etoposide regimens, which providesclinically relevant insights into underlying mechanisms driving tumorgrowth, resistance to current therapies and tumor recurrence.

As the NTX tumor cell lines were established, their phenotype wascharacterized in various ways to examine global gene expression. Toidentify which NTX lines in the bank might be NETs, gene expressionprofiles were generated by whole transcriptome sequencing and/ormicroarray analysis. Specifically, the data was examined to identifytumors expressing high levels of specific genes known to be elevated inNETs or used as histochemical markers of neuroendocrine differentiation(e.g., ASCL1, NCAM1, CHGA) as well as tumors with changes in NOTCHpathway genes indicative of suppression of NOTCH signaling (e.g.,reduced levels of NOTCH receptors, and changes to ligands and effectormolecules).

More particularly, upon establishing various NTX tumor cell lines as iscommonly done for human tumors in severely immune compromised mice, thetumors were resected after reaching 800-2,000 mm³ and the cells weredissociated and dispersed into suspension using art-recognized enzymaticdigestion techniques (see, for example, U.S.P.N. 2007/0292414 which isincorporated herein). The dissociated cell preparations from these NTXlines were then depleted of murine cells, and human tumor cellsubpopulations were then further isolated by fluorescence activated cellsorting and lysed in RLTplus RNA lysis buffer (Qiagen). These lysateswere then stored at −80° C. until used. Upon thawing, total RNA wasextracted using a RNeasy isolation kit (Qiagen) following the vendor'sinstructions and quantified on a Nanodrop spectrophotometer (ThermoScientific) and a Bioanalyzer 2100 (Agilent Technologies) again usingthe manufacturer's protocols and recommended instrument settings. Theresulting total RNA preparations were suitable for genetic sequencingand gene expression analysis.

Whole transcriptome sequencing using an Applied Biosystems (ABI) SOLiD(Sequencing by Oligo Ligation/Detection) 4.5 or SOLiD 5500xl nextgeneration sequencing system (Life Technologies) was performed on RNAsamples from NTX lines. cDNA was generated from total RNA samples usingeither a modified whole transcriptome (WT) protocol from ABI designedfor low input total RNA or Ovation RNA-Seq System V2™ (NuGENTechnologies Inc.). The modified low input WT protocol uses 1.0 ng oftotal RNA to amplify mRNA at the 3′ end which leads to a heavy 3′ biasof mapped gene expression, while NuGen's system allows for a moreconsistent amplification throughout the transcript, and includesamplification of both mRNA and non-polyadenylated transcript cDNA usingrandom hexamers. The cDNA library was fragmented, and barcodes adapterswere added to allow pooling of fragment libraries from differentsamples.

ABI's SOLiD 4.5 and SOLiD 5500xl next generation sequencing platformsenables parallel sequencing of transcriptomes from multiple NTX linesand sorted populations. A cDNA library is constructed from each RNAsample, which is fragmented and barcoded. Barcodes on each fragmentlibrary allow multiple samples to be pooled at equal concentrations andrun together while ensuring sample specificity. The samples are takenthrough emulsion PCR using ABI's SOLiD™ EZ Bead™ robotics system, whichensures sample consistency. Paired-end sequencing generates a 50 baseread in the 5′ to 3′ direction and a 25 base read in the 3′ to 5′direction for each clonally amplified fragment on a single bead thatexists in the pool. In the case of the 5500xl platform, for every set of8 samples pooled in the method mentioned above, beads are evenlydeposited into 6 single channel lanes on a single chip. This will, onaverage, generate more than 50 million 50 base reads and 50 million 25base reads for each of the 8 samples and generates a very accuraterepresentation of mRNA transcript level in the tumor cells. Datagenerated by the SOLiD platform mapped to 34,609 genes as annotated byRefSeq version 47 using NCBI version hg19.2 of the published humangenome and provided verifiable measurements of RNA levels in mostsamples.

The SOLiD platform is able to capture not only expression, but SNPs,known and unknown alternative splicing events, small non-coding RNAs,and potentially new exon discoveries based solely on read coverage(reads mapped uniquely to previously un-annotated genomic locations).Thus, use of this next generation sequencing platform paired withproprietary data analysis and visualization software thus allowed fordiscovery of differential transcript expression as well as differencesand/or preferences for specific splice variants of expressed mRNAtranscripts. Sequencing data from the SOLiD platform is nominallyrepresented as a transcript expression value using the metrics RPM(reads per million) and RPKM (read per kilobase per million), enablingbasic differential expression analysis as is standard practice.

Whole transcriptome sequencing of four small cell lung cancer (SCLC)tumors (LU73, LU64, LU86 and LU95), one ovarian tumor (OV26) and a largecell neuroendocrine carcinoma (LCNEC; LU37) resulted in thedetermination of gene expression patterns commonly found in NETs (FIG.6A). More specifically, these tumors had high expression of several NETmarkers (ASCL1, NCAM1, CHGA) as well as reduced levels of Notchreceptors and effector molecules (e.g., HES1, HEY1) and elevated markersof Notch suppression (e.g., DLL3 and HES6). In contrast, 4 normal lungsamples, 3 lung adenocarcinoma tumors (LU137, LU146 and LU153), and 3squamous cell lung carcinomas (LU49, LU70 and LU76) all have expressionof various Notch receptors and effector molecules, and do not showelevated expression of Notch suppressors such as HES6 and DLL3.

Moreover, as seen in FIG. 6B, an analysis of the whole transcriptomedata comparing normal tissue samples to various lung NTX populationshaving neuroendocrine features, showed that SEZ6 was up-regulated at themRNA transcript level in four lung cancer populations havingneuroendocrine features (LU73, LU64, LU86 and LU95) compared toextremely low or no transcript expression in the normal tissues tested.These results suggest that SEZ6 may play an important role in thetumorigenesis and maintenance of particular cancers (including lungcancers with neuroendocrine features). On this basis, SEZ6 was selectedfor further analysis as a potential immunotherapeutic target

Example 2 Microarray and RT-PCR Analysis of Gene Expression in SelectedNTX Tumors with Neuroendocrine Features

In an effort to identify additional NETs in the aforementioned NTX bankbeyond those for which SOLiD whole transcriptome data existed, a largerset of NTX lines was examined using microarray analysis. Specifically,2-6 μg of total RNA samples derived from whole tumors in 46 NTX lines orfrom 2 normal tissues were analyzed using a OneArray® microarrayplatform (Phalanx Biotech Group), which contains 29,187 probes designedagainst 19,380 genes in the human genome. More specifically, RNA sampleswere obtained (as described in Example 1) from forty-six patient derivedwhole NTX tumors comprising colorectal (CR), melanoma (SK), kidney (KD),lung (LU), ovarian (OV), endometrial (EM), breast (BR), liver (LIV), orpancreatic (PA) cancers. Normal colorectal (NormCR) and normal pancreas(NormPA) tissues were used as controls. Still more specifically, lungtumors were further subclassified as small cell lung cancers (SCLC),squamous cell cancers (SCC), or large cell neuroendocrine carcinoma(LCNEC). RNA samples were run in triplicate using the manufacturer'sprotocols and the resulting data was analyzed using standard industrypractices for normalizing and transforming the measured intensity valuesobtained for the subject gene in each sample. An unbiased PearsonSpearman hierarchical clustering algorithm in the R/BioConductor suiteof packages called hclust.2 was used to create a standard microarraydendrogram for these 48 samples. As known in the art R/BioConductor isan open-source, statistical programming language widely used inacademia, finance and the pharmaceutical industry for data analysis.Generally the tumors were arranged and clustered based on geneexpression patterns, expression intensity, etc.

As shown in FIG. 7A, the dendrogram derived from the 48 samples andacross all 19380 genes, clustered NTX lines together based upon theirtumor type or tissue of origin. Several tumors typically associated withneuroendocrine phenotypes clustered together on the branch denoted by(1); these included skin cancers, numerous lung cancers and other NETs.Interestingly, a sub-branch, denoted by (2), showed that two large celllung cancers with neuroendocrine features (LU50.LCNEC and LU37.LCNEC)and a small cell lung cancer (LU102.SCLC) clustered with an ovarian(OV26) and a kidney (KD66) tumor (cluster C) suggesting these latertumors also possessed neuroendocrine phenotypes. Moreover, FIG. 7A showscluster D which consists of 3 additional SCLC tumors, and to its rightis a small cluster (cluster E) containing an additional SCLC tumor(LU100) and a neuroendocrine endometrial tumor (EM6). All of the tumorsin clusters D and E are generally understood to possess someneuroendocrine features based on the academic literature and pathologyexperience in the clinic. The fact that cluster G, comprising SCC, canbe found on a completely different branch of the dendrogram of FIG. 7A,indicates that the clustering is not driven exclusively by the organ oforigin of the tumor.

Closer inspection of a collection of gene markers associated with NETs(FIG. 7B) shows that they are strongly expressed in tumors comprisingclusters C and D, while they are minimally expressed in tumors inCluster G (squamous cell carcinoma of the lung), suggesting clusters Cand D represent NETs or tumors with a neuroendocrine phenotype. Morespecifically, cluster C NETs highly express ASCL1, CALCA, CHGA, SST andNKX2-1, while cluster D NETs highly express CHGA, ENO2, and NCAM1, andit is the expression of these neuroendocrine phenotype genes that is inpart responsible for the clustering of these tumors. An interestingfeature is the strong expression of KIT in cluster D, a geneoccasionally reported to be associated with neuroendocrine tumors, butclearly linked to oncogenesis in other contexts. This is in contrast tothe SCC tumors in cluster G which lack strong expression any of thesegenes (FIG. 7B).

Tumors in cluster C show a phenotype consistent with a reduction inNotch signaling: a lack of expression of any Notch receptor, a relativelack of JAG1 and HES1 expression, and strong levels of ASCL1 expression(FIG. 7C). Interestingly, cluster D shows high expression of HES6, atranscription factor that can support ASCL1 activity by antagonizingHES1 activity through heterodimer formation.

In view of the aforementioned results, mRNA expression of HES6 wasexamined from various NTX lines and normal tissues using an AppliedBiosystems 7900HT Machine (Life Technologies) to perform Taqmanreal-time quantitative RT-PCR (qRT-PCR) in accordance with themanufacturer's protocols. RNA was isolated as described above andchecked to ensure quality was suitable for gene expression analysis. RNAfrom normal tissues was purchased (Agilent Technologies and LifeTechnologies). 200 ng of RNA was used for cDNA synthesis using the cDNAarchive kit (Life Technologies). cDNA was used for qRT-PCR analysis onTaqman Low Density Arrays (TLDA; Life Technologies) which contained theHES6 Taqman assay to measure mRNA levels of HES6.

HES6 mRNA levels are shown for each NTX line or normal tissue sample(single dot on graph) after normalization to endogenous controls.Normalized values are plotted relative to the average expression in thenormal tissues of toxicity concern (NormTox). This technique allowed forthe rapid identification and characterization of a variety of tumorshaving neuroendocrine features from the NTX tumor bank throughmeasurement of HES6 and other relevant markers. FIG. 7D illustratesgeneral overexpression of HES6 in the sampled tumors with neuroendocrinefeatures (e.g., LU-SCLC, LU-LCNEC) compared to normal tissues, breast,colon, liver and other selected tumors. Significantly these microarrayand qPCR data show that at least some endometrial, kidney and ovariantumors may exhibit neuroendocrine tumor features (FIGS. 7A and 7D).

The microarray data generated as described above not only showed thatthe tumors in clusters C, D and E exhibited various neuroendocrinemarkers, but also showed that the tumors in those clusters expressedmarkers indicative of neurogenesis, neural commitment, ordifferentiation towards neural fates (FIG. 7E). Of particular interest,the tumors in Cluster D frequently show a stronger and more consistentupregulation of many of these markers (e.g., BEX1 and BEX4, CD56, NRCAM,SEMA receptors, SOX and ZIC factors) and frequently reduced hormoneupregulation versus other clusters, suggesting a more neural phenotype.Remarkably, the tumors in those same clusters also showed high levels ofSEZ6 transcript, suggesting that SEZ6 is associated with tumors havingneuroendocrine and neural features (FIG. 7F).

Example 3 Expression of SEZ6 mRNA in Tumors having Neuroendocrine andNeural Features

Various techniques were used to identify tumors exhibitingneuroendocrine features including whole transcriptome sequencing(Example 1) and microarray and qRT-PCR (Example 2). The data thusgenerated was further analyzed in order to find potential therapeutictargets that are highly expressed in neuroendocrine tumors when comparedto non-neuroendocrine tumors and normal tissues. As discussed in Example1 it was found that SEZ6, a single pass transmembrane protein that ismainly expressed in the normal brain, has high expression in manyneuroendocrine tumors (FIG. 6B).

The microarray data generated in Example 2 showed that tumors located inclusters C, D and E expressed neuroendocrine markers (FIG. 7B) andneural markers (FIG. 7E). The tumors in those same clusters also showedhigh levels of SEZ6 transcript, suggesting that SEZ6 is associated withtumors having neuroendocrine and neural features (FIG. 7F). This is inline with the known role of SEZ6 in postnatal forebrain development andcontinued expression in the specific regions of the hippocampus in theadult. SEZ6 is thought to play important roles in cell-cell recognitionand signaling. Often developmental pathways are inappropriatelyexpressed in tumors.

In order to determine SEZ6 mRNA expression levels in various sample NTXtumor lines, qRT-PCR was performed using the SEZ6 Taqman assayessentially as described in Example 2 above. FIG. 8A shows SEZ6expression relative to the average expression in normal tissues andnormalized to expression of the endogenous control gene ALAS1. SEZ6 geneexpression is elevated more than 10,000,000-fold in neuroendocrine NTXpopulations versus normal tissues. Five of the SCLC NTX lines shown inFIG. 8A are mRNA samples extracted directly from primary biopsies (p0).The expression of SEZ6 in these unpassaged tumors demonstrates that SEZ6expression is not an artifact that results from growing human tumors inmice. Three subtypes of NSCLC are also represented in FIG. 8A: LU25 isspindle cell carcinoma, LU50 is a large cell neuroendocrine carcinoma(LCNEC), and LU85 is a squamous cell carcinoma (SCC). KDY66 and OV26, akidney and ovarian tumor, respectively, clustered on the microarray withSCLC and LCNEC tumors (FIG. 7A), suggesting they also haveneuroendocrine features.

To extend the analysis of SEZ6 expression to a wider array of tumorspecimens, qRT-PCR was performed using the Fluidigm BioMark™ HD System.Briefly, 1 ng of RNA, prepared as described in Example 1, was convertedto cDNA using the cDNA archive kit (Life Technologies). The cDNA waspre-amplified using a SEZ6 specific Taqman assay and was then used toperform qRT-PCR. Expression in normal tissues (NormTox or Norm) wascompared to expression in the following NTX lines, where the number inbrackets indicates the number of unique NTX lines tested: BR (13), CR(24), KDY (10), OV (35), PA (21), lung adenocarcinoma (LU-Adeno) (23),LU-CAR (1), LU-LCC (8), SCC (12),SCLC (30) and medullary thyroid cancer(THY) (1) (FIG. 8B). SCLC, THY LU-CAR and LC-LCC NTX show the highestexpression of SEZ6, although some expression of SEZ6 was also seen inOV, PA, BR, CR and LU-Adeno NTX lines compared to normal tissue samples.

“NormTox” represents the following samples of normal tissue: one adrenalgland, four colon, four kidney, four liver, three lung, three pancreas,three heart, three esophagus, one skeletal muscle, one skin, two dermalfibroblasts, two keratinocytes, three small intestine, one spleen, twostomach, and two trachea samples. Another set of normal tissuesdesignated

“NormTox” represents the following samples of normal tissue: adipose, Bcells, bladder, brain, breast, cervix, melanocytes, monocytes, NK cells,ovary, peripheral blood mononuclear cells, placenta, prostate, salivarygland, T cells, testes, thymus, and thyroid. Most normal tissues have noexpression of SEZ6, while low expression is seen in pancreas, colon,liver and lung and high expression in brain. A different SEZ6 specificTaqman assay, using essentially the same method as above, was conductedon various NTX tumor lines. The number of tumor lines that were testedfor each type of tumor is denoted as the denominator, whereas the numberof tumors that expressed SEZ6 is denoted as the numerator: 2/6 CR, 2/4GA, 1/1 GB (glioblastoma), 1/1 KDY, 2/6 SK, 2/5 LU-Adeno, 4/4 LCNEC, 2/7LU-SCC, 9/9 SCLC and 1/2 OV (data not shown).

Taken together, these data suggest that SEZ6 is upregulated in tumorsexhibiting neuroendocrine and neural features suggesting it may serve asa therapeutic target for treatment of these types of tumors.

Example 4 Expression of SEZ6 mRNA in Various Tumor and Normal TissueSpecimens Using qRT-PCR

To extend the analysis of SEZ6 expression to a wider array of tumorspecimens, Taqman qRT-PCR was performed substantially as described inthe previous Examples on a TissueScan™ qPCR (Origene Technologies)384-well array. This array enables comparison of gene expression across18 different solid tumor types, with multiple patient derived samplesfor each tumor type and from normal adjacent tissue.

In this regard, FIGS. 9A and 9B show the absolute and relative geneexpression levels, respectively, of SEZ6 in whole tumor specimens (greydots) or normal adjacent tissue (NAT; white dots) from patients with oneof eighteen different solid tumor types. More specifically, FIG. 9Ashows the absolute mRNA expression level of SEZ6 in various whole tumorspecimens or matched normal adjacent tissue. FIG. 9B shows theexpression level of SEZ6 as normalized against β-actin and plottedrelative to expression in normal adjacent tissue for each tumor typeanalyzed. Specimens in which SEZ6 was not detected were assigned a Ctvalue of 50, which represents the last cycle of amplification in theexperimental protocol. Each dot represents a single tissue specimen,with the geometric mean value represented as a black line.

Using this Origene Array, overexpression of SEZ6 was seen in a subset ofadrenal, liver, lung, ovarian, and pancreatic cancer, many of which mayrepresent neuroendocrine tumors or tumors with poorly differentiatedneuroendocrine phenotypes. This includes high expression in 1/1medullary thyroid cancer and 1/3 papillary carcinoma of the thyroidfollicular variant, 8/8 neuroendocrine pancreatic tumors, 4/4 pancreaticislet cell tumors, 1/2 large cell neuroendocrine lung carcinomas, and3/3 lung carcinoid tumors. As shown by the absolute gene expression inFIG. 9A, normal testis and pancreas are the only normal tissues withhigh expression of SEZ6. This suggests that SEZ6 may play a role intumorigenesis and/or tumor progression in a wide variety of tumorsincluding but not limited to those with neuroendocrine and neuralfeatures.

Example 5 Cloning and Expression of Recombinant SEZ6 Proteins

Human SEZ6 (hSEZ6)

The amino acid sequences of the SEZ6 isoform 1 (SEQ ID NO: 3) and SEZ6isoform 2 (SEQ ID NO: 4) proteins are set out in FIGS. 1C and 1D,respectively. The extracellular domain of each of the SEZ6 isoforms isidentical. In FIGS. 1C and 1D the leader sequence, comprising nineteenamino acids, is in bold and underlined. The rest of the amino acidresidues of each of SEQ ID NO: 3 and SEQ ID NO: 4 comprises the matureSEZ6 protein. In order to generate and develop all molecular andcellular materials required in the present invention pertaining to humanSEZ6, cDNA (FIG. 3A; SEQ ID NO: 5) encoding the complete mature humanSEZ6 protein (FIG. 3B, SEQ ID NO: 6) was created as follows. Acommercial human SEZ6 cDNA was purchased from Open Biosystems where thiscDNA sequence corresponded to NCBI accession BC146292. Sequencealignments showed the protein encoded by BC146292 differed by severalresidues from that of RefSeq NP_849191 (see residues 414, 415 and 417,FIG. 3C), encoding the endogenous human SEZ6 protein. PCR was used toamplify two separate cDNA fragments from the BC146292 clone, in whichthe primers used introduced the desired changes into the cDNA atresidues 414-417 during the process of overlap PCR to create a cDNAencoding a mature SEZ6 protein with identical sequence to that encodedby NM 178860, the mRNA sequence encoding endogenous human SEZ6 protein.The repaired cDNA clone, termed hSEZ6 (FIG. 3A), was used for allsubsequent engineering of constructs expressing the mature human SEZ6protein or fragments thereof.

In order to generate immunoreactive or immunospecific modulators to theSEZ6 molecule, a chimeric fusion gene was generated in which the ECDportion of the human SEZ6 protein was fused to the human IgG2 Fc domain(FIG. 4A, SEQ ID NO: 8). This was done as follows: cDNA encoding the ECDof SEZ6 was PCR amplified from the hSEZ6 cDNA clone (FIG. 3A), and thisPCR product was subsequently subcloned into a CMV driven expressionvector in frame and downstream of an IgK signal peptide sequence andupstream of a human IgG2 Fc cDNA, using standard molecular techniques.The cDNA sequence encoding the hSEZ6-Fc fusion protein, termed hSEZ6-FcORF, is shown in FIG. 4A; the corresponding protein sequence encoded byhSEZ6-Fc ORF is shown in FIG. 4B (SEQ ID NO: 9). The underlined regionsof the sequences correspond to the human IgG2 Fc. The bolded underlinedregions correspond to the IgK signal peptide, and the sequences in boldfont correspond to the portions of the fusion protein encoded by thecloning restriction sites flanking the SEZ6 ECD.

To generate recombinant hSEZ6 ECD protein a similar PCR-based strategywas used. The cDNA fragment encoding the ECD of SEZ6 was amplified fromthe hSEZ6 cDNA clone and subcloned into a CMV driven expression vectorin frame and downstream of an IgK signal peptide sequence and in frameupstream of a sequence encoding a 9-Histidine epitope tag (SEQ ID NO:201).

The CMV-driven expression vector permits high level transient expressionin HEK-293T and/or CHO-S cells. Suspension or adherent cultures ofHEK-293T cells, or suspension CHO-S cells were transfected withexpression constructs encoding either the hSEZ6 ECD-Fc or hSEZ6-ECD-Hisproteins, using polyethylenimine polymer as the transfecting reagent.Three to five days after transfection, the hSEZ6 ECD-Fc or hSEZ6-ECD-Hisproteins were purified from clarified cell-supernatants using an AKTAexplorer and either Mab Select SuRe™ Protein A (GE Healthcare LifeSciences) or Nickel-EDTA (Qiagen) columns, respectively.

A stable cell line overexpressing recombinant human SEZ6 was constructedusing lentiviral vectors to transduce HEK-293T cells as follows: PCRamplification was performed using the human SEZ6 clone as a template inorder to produce a cDNA fragment encoding the mature human SEZ6 protein.The fragment that was generated was subcloned in frame downstream of asequence encoding an IgK signal peptide and DDK epitope tag previouslyengineered upstream of the multiple cloning site of pCDH-EF1-MCS-T2A-GFP(System Biosciences) using standard molecular cloning techniques. Theresulting bicistronic lentiviral vector was used to engineer cell linesoverexpressing a human SEZ6-T2A peptide-GFP polypeptide. The T2Asequence promotes ribosomal skipping of a peptide bond condensation,resulting in two independent proteins, in this case SEZ6 and GFP.

Mouse SEZ6 (mSEZ6)

A stable cell line overexpressing recombinant mouse SEZ6 was engineeredessentially as described above for recombinant human SEZ6. HEK-293Tcells were transduced with a lentiviral vector expressing murine SEZ6.The vector was engineered essentially as follows. A cDNA fragment (FIG.5A; SEQ ID NO: 10) encoding the mature mouse SEZ6 protein listed asRefSeq NM_021286 in the NCBI database (FIG. 5B; SEQ ID NO: 11) wasobtained by PCR amplification from a commercial mouse SEZ6 cDNA(Origene; #MC203634) and subcloned downstream of an IgK signal peptidesequence and DDK epitope tag sequence previously engineered upstream ofthe multiple cloning site of pCDH-EF1-MCS-IRES-RFP (System Biosciences)using standard molecular cloning techniques. This yielded a bicistroniclentiviral vector that was used to produce a HEK-293T cell lineoverexpressing mouse SEZ6 and RFP.

Rat SEZ6 (rSEZ6)

To generate and develop all molecular and cellular materials required inthe present invention pertaining to rat SEZ6 proteins, cDNA (FIG. 5C,SEQ ID NO: 12) encoding the complete mature rat SEZ6 protein (FIG. 5D,SEQ ID NO: 13) was obtained as follows. A cDNA encoding the full lengthmature rat protein (i.e., the full length protein minus the wild-typesignal peptide) was amplified from rat brain marathon-ready cDNA(Clontech #639412). Sequence alignments showed the ECD of the encodedprotein to be homologous to the endogenous rat SEZ6 protein listed asRefSeq NP_001099224 in the NCBI database. This cDNA clone, termed rSEZ6(FIG. 5D), was used for subsequent engineering of constructs expressingthe rat SEZ6 protein fragments.

Cynomolgus SEZ6 (cSEZ6)

To generate and develop all molecular and cellular materials required inthe present invention pertaining to cynomolgus SEZ6 proteins, cDNA (FIG.5E, SEQ ID NO: 14) encoding the cynomolgus SEZ6 protein (FIG. 5F, SEQ IDNO: 15) was obtained as follows: A predicted cynomolgus SEZ6 ORFsequence was assembled by bioinformatics analysis in the following way:the ORF of the human SEZ6 gene was obtained from NCBI accessionNM_178860 and compared, using the BLAST algorithm, to the whole genomeshotgun sequencing contigs in the NCBI database. The BLAST results werethen used to assemble a putative cynomolgus SEZ6 ORF. The sequenceencoding the predicted wild-type signal peptide of cynomolgus SEZ6 wasremoved from this BLAST derived sequence, and replaced with a sequenceencoding an IgK signal peptide sequence. After codon optimization forproduction in mammalian cells, this complete hybrid ORF sequence wasordered as a synthetic gene (GeneWiz). This optimized cDNA clone, termedcSEZ6 (FIG. 5E), was used for subsequent engineering of constructsexpressing the cynomolgus SEZ6 protein fragments.

Human SEZ6L and SEZ6L2

In the human genome, there are two genes closely related to SEZ6-seizurerelated 6 homolog-like (SEZ6L) and seizure related 6 homolog like-2(SEZ6L2). Although the overall percent identity is relatively lowbetween the three proteins (˜42%), there are smaller stretches ofperfect identity between pairs or all three of the proteins. In order toinvestigate any possible cross reactivity of the anti-SEZ6 modulatorswith human SEZ6L and SEZ6L2 proteins, the open reading frames encodingthe ECDs of human SEZ6L protein (NP_0066938) and human SEZ6L2 protein(NP_001230261) were codon optimized and synthesized (GeneWiz). Theseoptimized cDNA sequences encoding the ECDs of human SEZ6L or SEZ6L2proteins are shown in FIGS. 5G and 5I.

Material for Cross-Reactivity Studies

Material was generated in order to study whether the SEZ6 modulators ofthe invention cross-reacted with rat and/or cynomolgus SEZ6 homologues,or with the closely related human SEZ6L and SEZ6L2 proteins. Chimericfusion genes were designed in which the ECD portion of either the rat orthe cynomolgus SEZ6 protein (underlined in FIGS. 5D and 5F,respectively) was fused to a 9-Histidine epitope tag (SEQ ID NO: 201).Using PCR, the cDNA fragment encoding the ECD of either rat orcynomolgus SEZ6 was amplified from either rSEZ6 or cSEZ6, respectively,and subcloned into a CMV driven expression vector in frame anddownstream of an IgK signal peptide sequence and in frame and upstreamof a sequence encoding a 9-Histidine epitope tag (SEQ ID NO: 201).Similarly, chimeric fusion genes were designed in which the open readingframe encoding the ECD portion of the human SEZ6L or SEZ6L2 proteins wassubcloned into a CMV driven expression vector in frame and downstream ofan IgK signal peptide sequence and in frame and upstream of a sequenceencoding a 9-Histidine epitope tag (SEQ ID NO: 201). The resultantencoded protein sequences for these fusion proteins are shown in FIGS.5H and 5J, respectively, with the underlined sequence representing theECD of the particular protein under consideration.

The rat and cynomolgus SEZ6 ECD-His vectors generated above, were usedto produce and purify recombinant rSEZ6-ECD-His protein andcSEZ6-ECD-His protein, respectively, as follows: using art-recognizedtechniques, suspension or adherent cultures of

HEK-293T cells, or suspension CHO-S cells were transfected with theexpression vectors encoding rSEZ6-ECD-His or cSEZ6-ECD-His protein.Polyethylenimine polymer was used as the transfecting reagent. Three tofive days after transfection, the rSEZ6-ECD-His or cSEZ6-ECD-His proteinwas purified from clarified cell-supernatants using AKTA explorer andNickel-EDTA (Qiagen) columns. Similarly, the human SEZ6L and SEZ6L2ECD-His vectors were used to produce and purify recombinant human SEZ6Land human SEZ6L2 ECD-His proteins, as described for the rat andcynomolgus homologs.

Example 6 Generation of Anti-SEZ6 Murine Modulators

SEZ6 modulators in the form of murine antibodies were produced inaccordance with the teachings herein through inoculation with humanSEZ6-Fc. In this regard three strains of mice were used to generate highaffinity, murine, monoclonal antibody modulators that can be used toassociate with and/or inhibit the action of SEZ6 for the preventionand/or treatment of various proliferative disorders. Specifically,Balb/c, CD-1 and FVB mouse strains were immunized with human recombinantSEZ6-Fc and used to produce Hybridomas.

The SEZ6-Fc antigen was purified from supernatant from CHO-S cells overexpressing the construct SEZ6-Fc as set forth in Example 5 (FIGS. 4A and4B). 10 μg of SEZ6-Fc immunogen was used for the first immunization,followed by 5 μg and 2.5 μg of SEZ6-Fc immunogen for the subsequentthree immunizations and five immunizations, respectively. Allimmunizations were performed with the immunogen emulsified with an equalvolume of TITERMAX° Gold (CytRx Corporation) or alum adjuvant. Murineantibodies were generated by immunizing six female mice (two each of:Balb/c, CD-1, FVB) via footpad route for all injections.

Solid-phase ELISA assays were used to screen mouse sera for mouse IgGantibodies specific for human SEZ6. A positive signal above backgroundwas indicative of antibodies specific for SEZ6. Briefly, 96 well plates(VWR International, Cat. #610744) were coated with recombinant SEZ6-Hisat 0.5 μg/ml in ELISA coating buffer overnight. After washing with PBScontaining 0.02% (v/v) Tween 20, the wells were blocked with 3% (w/v)BSA in PBS, 200 μIL/well for 1 hour at room temperature (RT). Mouseserum was titrated (1:100, 1:200, 1:400, and 1:800) and added to theSEZ6 coated plates at 50 μIL/well and incubated at RT for 1 hour. Theplates are washed and then incubated with 50 μIL/well HRP-labeled goatanti-mouse IgG diluted 1:10,000 in 3% BSA-PBS or 2% FCS in PBS for 1hour at RT. Again the plates were washed and 40 μIL/well of a TMBsubstrate solution (Thermo Scientific 34028) was added for 15 minutes atRT. After developing, an equal volume of 2N H₂SO₄ was added to stopsubstrate development and the plates were analyzed by spectrophotometerat OD 450.

Sera-positive immunized mice were sacrificed and draining lymph nodes(popliteal and inguinal, and medial iliac if enlarged) were dissectedout and used as a source for antibody producing cells. A single cellsuspension of B cells (228.9×10⁶ cells) was fused with non-secretingP3x63Ag8.653 myeloma cells (ATCC #CRL-1580) at a ratio of 1:1 byelectrofusion. Electrofusion was performed using the BTX Hybrimmune™System, (BTX Harvard Apparatus) as per the manufacturer's directions.After the fusion procedure the cells were resuspended in hybridomaselection medium supplemented with Azaserine (Sigma #A9666), highglucose DMEM medium with sodium pyruvate (Cellgro cat#15-017-CM)containing 15% Fetal Clone I serum (Hyclone), 10% BM Condimed (RocheApplied Sciences), 4 mM L-glutamine, 100 IU Penicillin-Streptomycin and50 μM 2-mercaptoethanol and then plated in three T225 flasks in 90 mLselection medium per flask. The flasks were then placed in a humidified37° C. incubator containing 5% CO₂ and 95% air for 6-7 days.

After six to seven days of growth the library consisting of the cellsgrown in bulk in the T225s was plated at 1 cell per well in Falcon 96well U-bottom plates using the Aria I cell sorter. The selectedhybridomas were then grown in 200 μL of culture medium containing 15%Fetal Clone I serum (Hyclone), 10% BM-Condimed (Roche Applied Sciences),1 mM sodium pyruvate, 4 mM L-glutamine, 100 IU Penicillin-Streptamycin,50 μM 2-mercaptoethanol, and 100 μM hypoxanthine. Any remaining unusedhybridoma library cells were frozen for future library testing. Afterten to eleven days of growth supernatants from each well of the platedcells were assayed for antibodies reactive for SEZ6 by ELISA and FACSassays.

For screening by ELISA 96 well plates were coated with SEZ6-Fc at 0.3μg/mL in PBS overnight at 4° C. The plates were washed and blocked with3% BSA in PBS/Tween for one hour at 37° C. and used immediately or keptat 4° C. Undiluted hybridoma supernatants were incubated on the platesfor one hour at RT. The plates were washed and probed with HRP labeledgoat anti-mouse IgG diluted 1:10,000 in 3% BSA-PBS for one hour at RT.The plates were then incubated with substrate solution as describedabove and read at OD 450. Wells containing immunoglobulin thatpreferentially bound human SEZ6, as determined by a signal abovebackground, were transferred and expanded.

Selected growth positive hybridoma wells secreting murine immunoglobulinwere also screened for human SEZ6 specificity and cynomolgus, rat andmurine SEZ6 cross reactivity using a flow cytometry based assay with 293cells engineered to over-express the selected antigen or constructsfabricated in the previous Example.

For the flow cytometry assays, 50×10⁴ h293 cells transduced respectivelywith human, cynomolgus, rat or murine SEZ6 were incubated for 30 minuteswith 25-100 μL hybridoma supernatant. Cells were washed with PBS, 2%FCS, twice and then incubated with 50 μL of a goat-anti-mouse IgG Fcfragment specific secondary conjugated to DyLight 649 diluted 1:200 inPBS/2% FCS. After 15 minutes of incubation, cells were washed twice withPBS, 2% FCS, and re-suspended in the same buffer with DAPI and analyzedby flow cytometry using a FACSCanto II as per the manufacturer'sinstructions. Wells containing immunoglobulin that preferentially boundthe SEZ6⁺ GFP⁺ cells were transferred and expanded. The resulting hSEZ6specific clonal hybridomas were cryopreserved in CS-10 freezing medium(Biolife Solutions) and stored in liquid nitrogen. Antibodies that boundwith human, cynomolgus, rat or murine SEZ6 cells were noted ascross-reactive (see FIG. 11A).

ELISA and flow cytometry analysis confirmed that purified antibody frommost or all of these hybridomas bound SEZ6 in a concentration-dependentmanner. Wells containing immunoglobulin that bound SEZ6 GFP cells weretransferred and expanded. The resulting clonal hybridomas werecryopreserved in CS-10 freezing medium (Biolife Solutions) and stored inliquid nitrogen.

One fusion was performed and seeded in 48 plates (4608 wells atapproximately 40% cloning efficiency). The initial screen yieldedsixty-three murine antibodies that associated with human SEZ6. A secondscreen was subsequently performed and yielded 134 antibodies thatassociated with human SEZ6.

Example 7 Sequencing of SEZ6 Murine Modulators

Based on the foregoing, a number of exemplary distinct monoclonalantibodies that bind immobilized human SEZ6 or h293-hSEZ6 cells withapparently high affinity were selected for sequencing and furtheranalysis. As shown in a tabular fashion in FIGS. 10A and 10B, sequenceanalysis of the light chain variable regions (FIG. 10A) and heavy chainvariable regions (FIG. 10B) from selected monoclonal antibodiesgenerated in Example 6 confirmed that many had novel complementaritydetermining regions and often displayed novel VDJ arrangements. Notethat the complementarity determining regions set forth in FIGS. 10A and10B are defined as per Kabat et al., supra.

As a first step in sequencing exemplary modulators, the selectedhybridoma cells were lysed in Trizol® reagent (Trizol Plus RNAPurification System, Life Technologies) to prepare the RNA. In thisregard between 10⁴ and 10⁵ cells were resuspended in 1 mL Trizol andshaken vigorously after addition of 200 μL of chloroform. Samples werethen centrifuged at 4° C. for 10 minutes and the aqueous phase wastransferred to a fresh microfuge tube where an equal volume ofisopropanol was added. The tubes were again shaken vigorously andallowed to incubate at RT for 10 minutes before being centrifuged at 4°C. for 10 minutes. The resulting RNA pellets were washed once with 1 mLof 70% ethanol and dried briefly at RT before being resuspended in 40 μLof DEPC-treated water. The quality of the RNA preparations wasdetermined by fractionating 3 μL in a 1% agarose gel before being storedat −80° C. until used.

The variable region of the Ig heavy chain of each hybridoma wasamplified using a 5′ primer mix comprising thirty-two mouse specificleader sequence primers, designed to target the complete mouse V_(H)repertoire, in combination with a 3′ mouse Cγ primer specific for allmouse Ig isotypes. A 400 bp PCR fragment of the V_(H) was sequenced fromboth ends using the same PCR primers. Similarly a mix of thirty-two 5′Vκ leader sequence primers designed to amplify each of the Vκ mousefamilies combined with a single reverse primer specific to the mousekappa constant region were used to amplify and sequence the kappa lightchain. The V_(H) and V_(L) transcripts were amplified from 100 ng totalRNA using reverse transcriptase polymerase chain reaction (RT-PCR).

A total of eight RT-PCR reactions were run for each hybridoma: four forthe Vκ light chain and four for the V gamma heavy chain (γ1). The OneStep RT-PCR kit was used for amplification (Qiagen). This kit provides ablend of Sensiscript and Omniscript Reverse Transcriptases, HotStarTaqDNA Polymerase, dNTP mix, buffer and Q-Solution, a novel additive thatenables efficient amplification of “difficult” (e.g., GC-rich)templates. Reaction mixtures were prepared that included 3 μL of RNA,0.5 of 100 μM of either heavy chain or kappa light chain primers (customsynthesized by IDT), 5 μL of 5× RT-PCR buffer, 1 μL dNTPs, 1 μL ofenzyme mix containing reverse transcriptase and DNA polymerase, and 0.4μL of ribonuclease inhibitor RNasin (1 unit). The reaction mixturecontains all of the reagents required for both reverse transcription andPCR. The thermal cycler program was set for an RT step 50° C. for 30minutes, 95° C. for 15 minutes, followed by 30 cycles of PCR (95° C. for30 seconds, 48° C. for 30 seconds, 72° C. for one minute). There wasthen a final incubation at 72° C. for 10 minutes.

To prepare the PCR products for direct DNA sequencing, they werepurified using the QIAquick™ PCR Purification Kit (Qiagen) according tothe manufacturer's protocol. The DNA was eluted from the spin columnusing 50 μL of sterile water and then sequenced directly from bothstrands. The extracted PCR products were directly sequenced usingspecific V region primers. Nucleotide sequences were analyzed using IMGTto identify germline V, D and J gene members with the highest sequencehomology. The derived sequences were further compared to known germlineDNA sequences of the Ig V- and J-regions using V-BASE2 (Retter et al.,supra) and by alignment of V_(H) and V_(L) genes to the mouse germlinedatabase to assist with fabrication of the humanized constructs as setforth below.

More specifically, FIG. 10A depicts the contiguous amino acid sequencesof seventy-four unique novel murine light chain variable regions fromanti-SEZ6 antibodies (SEQ ID NOS: 20-168, even numbers) and elevenhumanized light chain variable regions (SEQ ID NOS: 170-192, evennumbers) derived from representative murine light chains. Similarly,FIG. 10B depicts the contiguous amino acid sequences of seventy-fourunique novel murine heavy chain variable regions (SEQ ID NOS: 21-169,odd numbers) from the same anti-SEZ6 antibodies and eleven humanizedheavy chain variable regions ((SEQ ID NOS: 171-193, odd numbers) fromthe same murine antibodies providing the humanized light chains. Thus,taken together FIGS. 10A and 10B provide the annotated sequences ofseventy-four unique operable murine anti-SEZ6 antibodies (termed SC17.1,SC17.2, SC17.3, SC17.4, SC17.8, SC17.9, SC17.10, SC17.11, SC17.14,SC17.15, SC17.16 (duplicate of SC17.6), SC17.17, SC17.18, SC17.19,SC17.22, SC17.24 (duplicate sequence of SC17.2), SC17.27, SC17.28,SC17.29, SC17.30, SC17.32, SC17.34, SC17.35, SC17.36, SC17.38, SC17.39,SC17.40, SC17.41, SC17.42, SC17.45, SC17.46, SC17.47, SC17.49, SC17.50,SC17.53, SC17.54, SC17.56, SC17.57, SC17.59, SC17.61, SC17.63, SC17.71,SC17.72, SC17.74, SC17.76, SC17.77, SC17.79, SC17.81, SC17.82, SC17.84,SC17.85, SC17.87, SC17.89, SC17.90, SC17.91, SC17.93, SC17.95, SC17.97,SC17.99, SC17.102, SC17.114, SC17.115, SC17.120, SC17121, SC17.122,SC17.140, SC17.151, SC17.156, SC17.161, SC17.166, SC17.187, SC17.191,SC17.193, SC17.199 and SC17.200) and eleven humanized antibodies (termedhSC17.16, hSC17.17, hSC17.24, hSC17.28, hSC17.34, hSC17.46, hSC17.151,hSC17.155, hSC17.156, hSC17.161 and hSC17.200). Note that these samedesignations may refer to the clone that produces the subject antibodyand, as such, the use of any particular designation should beinterpreted in the context of the surrounding disclosure.

Additionally, hSC17.200vL1 (SEQ ID NO: 192) is a variant of thehumanized light chain construct hSC17.200 (SEQ ID NO: 190),hSC17.155vH1-hSC17.155vH6 (SEQ ID NOS: 193-198) are variants of theheavy chain construct hSC.155 (SEQ ID NO: 184) which is derived fromSC17.90 (SEQ ID NO: 127) and that hSC161vH1 (SEQ ID NO: 199) is avariant of the heavy chain construct hSC17.161 (SEQ ID NO: 189). As willbe discussed in more detail below these variants were constructed andtested to optimize one or more biochemical properties of the parentantibody.

Further, corresponding nucleic acid sequences of each of theseventy-four exemplary murine modulators and eleven humanized modulatorsand variants set forth in FIGS. 10A and 10B are included in the sequencelisting of the instant application (SEQ ID NOS: 220-399).

For the purposes of the instant application the SEQ ID NOS of eachparticular antibody are sequential. Thus mAb SC17.1 comprises SEQ IDNOS: 20 and 21 for the light and heavy chain variable regionsrespectively. In this regard SC17.2 comprises SEQ ID NOS: 22 and 23,SC17.9 comprises SEQ ID NOS: 24 and 25, and so on. Moreover,corresponding nucleic acid sequences for each antibody amino acidsequence in FIGS. 10A and 10B are set forth in the sequence listing. Inthe sequence listing the included nucleic acid sequences comprise SEQ IDNOS that are two hundred greater than the corresponding amino acidsequence (light or heavy chain). Thus, nucleic acid sequences encodingthe light and heavy chain variable region amino acid sequences of mAbSC17.1 (i.e., SEQ ID NOS: 20 and 21) comprise SEQ ID NOS: 220 and 221.In this regard nucleic acid sequences encoding all of the disclosedlight and heavy chain variable region amino acid sequences, includingthose encoding the humanized constructs and variants thereof, arenumbered similarly and comprise SEQ ID NOS: 220-399.

Example 8 Generation of Chimeric and Humanized SEZ6 Modulators

As alluded to above, eleven of the murine antibodies from Example 7 werehumanized using complementarity determining region (CDR) grafting. Humanframeworks for heavy and light chains were selected based on sequenceand structure similarity with respect to functional human germlinegenes. In this regard structural similarity was evaluated by comparingthe mouse canonical CDR structure to human candidates with the samecanonical structures as described in Chothia et al. (supra).

More particularly eleven murine antibodies SC17.16, SC17.17, SC17.24,SC17.28, SC17.34, SC17.46, SC17.151, SC17.155 (duplicate of SC17.90),SC17.156, SC17.161 and SC17.200 were humanized using a computer-aidedCDR-grafting method (Abysis Database, UCL Business Plc.) and standardmolecular engineering techniques to provide hSC17.16, hSC17.17,hSC17.24, hSC17.28, hSC17.34, hSC17.46, hSC17.151, hSC17.155, hSC17.156,hSC17.161 and hSC17.200 modulators. The human framework regions of thevariable regions were selected based on their highest sequence homologyto the subject mouse framework sequence and its canonical structure. Forthe purposes of the humanization analysis, the assignment of amino acidsto each of the CDR domains is in accordance with Kabat et al. numbering(supra).

Molecular engineering procedures were conducted using art-recognizedtechniques. To that end total mRNA was extracted from the hybridomas andamplified as set forth in Example 7 immediately above.

From the nucleotide sequence information, data regarding V, D and J genesegments of the heavy and light chains of subject murine antibodies wereobtained. Based on the sequence data new primer sets specific to theleader sequence of the Ig V_(H) and V_(K) light chain of the antibodieswere designed for cloning of the recombinant monoclonal antibody.Subsequently the V-(D)-J sequences were aligned with mouse Ig germ linesequences. The resulting genetic arrangements for each of the elevenhumanized constructs are shown in Table 3 immediately below.

TABLE 3 human human human FW human FW mAb VH DH JH changes human VK JKchanges hSC17.16 IGHV1-2 IGHD3-16 JH5 none IGKV-O2 JK1 none hSC17.17IGHV1-2 IGHD4-11 JH4 none IGKV-L6 JK2 none hSC17.24 VH1-f IGHD5-12 JH448I, 73K VKB3 JK1 none hSC17.28 IGHV1-2 IGHD3-16 JH4 none IGKV-A10 JK4none hSC17.34 IGHV1-3 IGHD3-10 JH4 71V IGKV-L1 JK1 71Y hSC17.46 IGHV1-2IGHD4-23 JH4 48I, 69L IGKV-L11 JK1 87F hSC17.151 IGHV1-46 IGHD1-14 JH4none VKL6 JK2 none hSC17.155 IGHV1-46 IGHD2-2 JH4 none VKB3 JK1 nonehSC17.156 IGHV2-26 IGHD4-17 JH4 none VKO1 JK4 none hSC17.161 IGHV1-2IGHD1-14 JH4 none VKB3 JK2 none hSC17.200 IGHV5-51 IGHD4-17 JH4 noneIGKV-L6 JK4 none

The humanized antibodies listed in Table 3 correspond to the annotatedlight and heavy chain sequences set forth in FIGS. 10A and 10B (SEQ IDNOS: 170-191). The corresponding nucleic acid sequences of the light andheavy chain variable regions are set forth in the appended sequencelisting. Table 3 further demonstrates that very few framework changeswere necessary to maintain the favorable properties of the bindingmodulators. In this respect framework changes or back mutations wereonly made in three of the heavy chain variable regions and only twoframework modifications were undertaken in the light chain variableregions.

Note that, for some humanized light and heavy chain variable regionsamino acid mutations were introduced in the FRs or CDRs to improvestability while maintaining antigen binding. In the case of SC17.155 sixvariants were produced, termed hSC17.155vH1-hSC17.155vH6. In each ofthese variants changes were made to the FR or CDRs of the heavy chainvariable region of hSC17.155 while the light chain variable region wasleft unchanged. In the case of hSC17.155vH1 and hSC17.155vH2 a pointmutation was introduced in FR1 (SEQ ID NOS: 471 and 472) of the heavychain variable region of hSC17.155. In the case of hSC17.155vH3 a pointmutation was introduced in CDRH1 (SEQ ID NO: 473) of the hSC17.155 heavychain variable region. In the case of hSC17.155vH4-hSC17.155vH6 pointmutations were introduced in CDRH2 (SEQ ID NOS: 474, 475 and 476,respectively) of the hSC17.155 heavy chain variable region. In the caseof hSC17.161 certain amino acids in FR1 (SEQ ID NO: 477); FR2 (SEQ IDNO: 478) and FR3 (SEQ ID NO: 479) of the heavy chain variable regionwere changed whereas the light chain variable region was not modified.Finally, in the case of hSC200vL1 a point mutation was introduced inCDRL1 (SEQ ID NO:

480) of the hSC17.200 light chain variable region and the heavy chainvariable region was not modified. In each case, the binding affinity ofthe antibodies with modified CDRs or FRs was found to be equivalent toeither the corresponding chimeric or murine antibody. The sequences ofnine exemplary humanized variant chains (light and heavy,) are listed atthe end of FIGS. 10A and 10B (SEQ ID NOS: 192-199) where they retain thedesignation of the humanized parent chain with notation to indicate theyhave been altered (e.g. hSC17.200vL1, hSC17.155vH1-6 and hSC17.161vH1).The full length amino acid sequences of exemplary humanized antibodies,hSC17.200 and hSC17.200vL1 are set out in FIG. 10C as SEQ ID NOs:400-402. The humanized antibody variant hSC17.200vL1 is derived fromhumanized antibody hSC17.200 and shares a common HC with the hSC17.200antibody. Thus the full length LC and HC of hSC17.200 correspond to SEQID NOs: 400 and 401, respectively; and the full length LC and HC ofhSC17.200vL1 correspond to SEQ ID NOs: 403 and 401, respectively.Following humanization of all selected antibodies by CDR grafting, theresulting light and heavy chain variable region amino acid sequenceswere analyzed to determine their homology with regard to the murinedonor and human acceptor light and heavy chain variable regions. Theresults, shown in Table 4 below, reveal that the humanized constructsconsistently exhibited a higher homology with respect to the humanacceptor sequences than with the murine donor sequences. Morespecifically, the humanized heavy and light chain variable regionsgenerally show a higher percentage homology to a closest match of humangermline genes (84%-95%) as compared to the homology of the humanizedvariable region sequences and the donor hybridoma protein sequences(74%-89%).

TABLE 4 Homology to Human Homology to Murine Parent mAb (CDR acceptor)(CDR donor) hSC17.16 HC 91% 80% hSC17.16 LC 86% 85% hSC17.17 HC 93% 80%hSC17.17 LC 87% 77% hSC17.24 HC 86% 79% hSC17.24 LC 93% 89% hSC17.28 HC89% 77% hSC17.28 LC 92% 78% hSC17.34 HC 85% 83% hSC17.34 LC 84% 86%hSC17.46 HC 85% 83% hSC17.46 LC 84% 80% hSC17.151 HC 90% 79% hSC17.151LC 87% 80% hSC17.155 HC 90% 80% hSC17.155 LC 95% 87% hSC17.156 HC 89%79% hSC17.156 LC 86% 93% hSC17.161 HC 89% 86% hSC17.161 LC 93% 87%hSC17.200 HC 90% 74% hSC17.200 LC 88% 82%

Upon testing, and as will be discussed in Example 9, each of thehumanized constructs exhibited favorable binding characteristics roughlycomparable to those shown by the murine parent antibodies (Data notshown).

Whether humanized or murine, once the nucleic acid sequences of thevariable regions are determined the antibodies of the instant inventionmay be expressed and isolated using art-recognized techniques. To thatend synthetic DNA fragments of the chosen heavy chain (humanized ormurine) variable region were cloned into a human IgG1 expression vector.Similarly the variable region light chain DNA fragment (again humanizedor murine) was cloned into a human light chain expression vector. Theselected antibody was then expressed by co-transfection of the derivedheavy and the light chain nucleic acid constructs into CHO cells.

More particularly, one compatible method of antibody productioncomprised directional cloning of murine or humanized variable regiongenes (amplified using PCR) into selected human immunoglobulinexpression vectors. All primers used in Ig gene-specific PCRs includedrestriction sites which allowed direct cloning into expression vectorscontaining human IgG1 heavy chain and light chain constant regions. Inbrief, PCR products were purified with Qiaquick PCR purification kit(Qiagen) followed by digestion with Agel and Xhol (for the heavy chain)and XmaI and DraIII (for the light chain), respectively. Digested PCRproducts were purified prior to ligation into expression vectors.Ligation reactions were performed in a total volume of 10 μL with 200UT4-DNA Ligase (New England Biolabs), 7.5 μL of digested and purifiedgene-specific PCR product and 25 ng linearized vector DNA. Competent E.coli DH10B bacteria (Life Technologies) were transformed via heat shockat 42° C. with 3 μL ligation product and plated onto ampicillin plates(100 μg/mL). The AgeI-EcoRI fragment of the V_(H) region was thaninserted into the same sites of pEE6.4HuIgG1 expression vector while thesynthetic XmaI-DraIII VK insert was cloned into the XmaI-DraIII sites ofthe respective pEE12.4Hu-Kappa expression vector.

Cells producing the selected antibody were generated by transfection ofHEK 293 cells with the appropriate plasmids using 293fectin. In thisrespect plasmid DNA was purified with QIAprep Spin columns (Qiagen).Human embryonic kidney (HEK) 293T (ATCC No CRL-11268) cells werecultured in 150 mm plates (Falcon, Becton Dickinson) under standardconditions in Dulbecco's Modified Eagle's Medium (DMEM) supplementedwith 10% heat inactivated FCS, 100 μg/mL streptomycin, 100 U/mLpenicillin G (all from Life Technologies).

For transient transfections cells were grown to 80% confluency. Equalamounts of IgH and corresponding IgL chain vector DNA (12.5 μg of each)was added to 1.5 mL Opti-MEM mixed with 50 μL HEK 293 transfectionreagent in 1.5 mL opti-MEM. The mix was incubated for 30 min at roomtemperature and distributed evenly to the culture plate. Supernatantswere harvested three days after transfection, replaced by 20 mL of freshDMEM supplemented with 10% FBS and harvested again at day 6 aftertransfection. Culture supernatants were cleared of cell debris bycentrifugation at 800×g for 10 min and stored at 4° C. Recombinantchimeric and humanized antibodies were purified with Protein G beads (GEHealthcare) and stored under appropriate conditions.

Example 9 Characteristics of SEZ6 Modulators

Various methods were used to analyze the binding and immunochemicalcharacteristics of selected SEZ6 modulators generated as set forthabove. Specifically, a number of the antibody modulators werecharacterized as to affinity, binning, and cross reactivity with regardto human, cynomolgus, rat and mouse SEZ6 antigen along with SEZ6L andSEZ6L2 proteins by art-recognized methods including flow cytometry.Affinities and kinetic constants k_(on) and k_(off) of the selectedmodulators were measured using bio-layer interferometry analysis on aForteBio RED (ForteBio, Inc.) or surface plasmon resonance using aBiacore 2000 each according to the manufacturer's instructions.

The characterization results are set forth in tabular form in FIG. 11Awhere it may be seen that the selected modulators generally exhibitedrelatively high affinities in the nanomolar range and, in many cases,were cross-reactive with one or more SEZ6 orthologs. FIG. 11A furtherlists the empirically determined bin occupied by the subject modulator.Taken together, these data demonstrate the varied binding properties ofthe disclosed modulators as well as their potential suitability forpharmaceutical development based on their reactivity in animal models.

In this regard flow cytometry was performed using a FACSCanto II as perthe manufacturer's instructions in order to confirm that selected SC17antibody modulators can immunospecifically associate with human SEZ6 andto determine whether the same modulators cross-react with cynomolgus,rat and/or murine SEZ6 in addition to SEZ6L and SEZ6L2. Moreparticularly modulators were tested for cross reactivity to murine SEZ6and rat SEZ6 by flow cytometry against Neuro2a (ATCC Cat #CCL131), andRIN-m5F (ATCC cat #CRL-11605) cell lines which express mouse SEZ6 andrat SEZ6, respectively. For examining cross reactivity to cynomolgusSEZ6, yeast displaying the extracellular domain of cynomolgus SEZ6(Boder et al, 1997) were used for flow cytometry analysis.

Briefly 1×10⁵ cells per well of Neuro2a, RIN-5mF, or yeast displayingcynomolgus SEZ6 cells were incubated for 30 minutes with 50 μL PBS (2%FCS) buffer with 5 μg/mL antibody. Cells were washed twice with the samebuffer and then incubated with 50 μL per sample DyLight 649 labeledgoat-anti-mouse IgG, Fc fragment specific secondary diluted 1:200 in PBSbuffer. After incubating for 15 minutes cells were washed twice with thePBS buffer and re-suspended in the same with DAPI for flow cytometryanalysis of Neuro2a and Rin-m5F or buffer without DAPI for flowcytometric analysis of yeast cells with cSEZ6. Antibodies that bound tothe Neuro2a or RIN-m5F cell lines, or yeast displaying cynomolgus SEZ6were considered to be cross reactive to murine SEZ6, rat SEZ6, orcynomolgus SEZ6, respectively. FIG. 11A shows the cross reactivityresults. Six antibodies were cross reactive for human and mouse SEZ6(SC17.6 (duplicate of SC17.16), SC17.7, SC17.19, SC17.24, SC17.26 andSC17.42); six for human and rat SEZ6 (SC17.6, SC17.17, SC17.19, SC17.26,SC17.28, SC17.34 and SC17.42); and six for human and cynomolgus SEZ6(SC17.17, SC17.24, SC17.26, SC17.34, SC17.36 and SC17.45). Note thatSC17.6 is duplicative of SC17.16 and exhibits the same bindingcharacteristics.

To verify the cross reactivity data above for rat SEZ6 and to determinethe affinity and kinetic constants k_(on) and k_(off) of the selectedeffectors, either bio-layer interferometry analysis on a ForteBio RED(ForteBio, Inc.) or surface plasmon resonance on a Biacore 2000 (GEHealthcare) were conducted. Affinities were determined to both humanrecombinant SEZ6-His and rat recombinant SEZ6-His generated in Example5. As seen in FIG. 11A, a number of the antibodies tested, cross reactedwith rat SEZ6. The selected modulators exhibited relatively highaffinities for both rat and human SEZ6 in the nanomolar range.

To determine cross reactivity to family member proteins, SEZ6L andSEZ6L2, an ELISA-based assay was used. Plates were coated with SEZ6,SEZ6L, or SEZ6L2 proteins at 0.2 μg/mL in PBS overnight. After washingwith PBS containing 0.05% (v/v) Tween 20 (PB ST), the wells were blockedwith 2% (w/v) BSA in PBS (PB SA), 100 μL/well for 1 hour at roomtemperature. Antibody was then added at 1 μg/mL in 100 μL PBSA for 1hour at room temperature. After washing with PBST, 100 μL/wellHRP-labeled goat anti-mouse IgG diluted 1:2,000 in PBSA for 1 hour atroom temperature. The plates were washed and 100 μL/well of the TMBsubstrate solution (Thermo Scientific 34028) was added for 15 minutes atroom temperature. After developing, an equal volume of 2M H₂SO₄ wasadded to stop substrate development and analyzed by spectrophotometer atOD 450. FIG. 11A shows that one antibody was cross reactive with SEZ6L(SC17.7) and five were cross-reactive with SEZ6L2 (SC17.6, SC17.7,SC17.19, SC17.26 and SC17.28). As discussed above, such pan-SEZ6antibodies are compatible with the teachings herein and may be used inconjunction with the disclosed methods.

Binding characteristics of the following humanized constructs fromExample 8, hSC17.16, hSC17.17, hSC17.24, hSC17.28, hSC17.34 andhSC17.46, were analyzed in order to determine whether the CDR graftingprocess had appreciably altered their binding characteristics. Thehumanized constructs (CDR grafted) were compared with “traditional”chimeric antibodies comprising the murine parent (or donor) heavy andlight chain variable domains and a human constant region substantiallyequivalent to that used in the humanized constructs. With theseconstructs surface plasmon resonance was conducted using a Biacore 2000(GE Healthcare) to identify any subtle changes in rate constants broughtabout by the humanization process. In all cases, the humanizedantibodies had binding affinity equivalent or better than thecorresponding murine antibodies (Data not shown).

Antibody binning was determined for various SEZ6 modulators as shown inFIG. 11A. A ForteBio RED was used per manufacturer's instructions toidentify competing antibodies that bound to the same or different bins.Briefly, a reference antibody (Ab1) was captured onto an anti-mousecapture chip, a high concentration of non-binding antibody was then usedto block the chip and a baseline was collected. Monomeric, recombinanthuman SEZ6 (described in Example 5) was then captured by the specificantibody (Ab1) and the tip was dipped into a well with either the sameantibody (Ab1) as a control or into a well with a different testantibody (Ab2). If additional binding was observed with a new antibody,then Ab1 and Ab2 were determined to be in a different bin. If no furtherbinding occurred, as determined by comparing binding levels with thecontrol Ab1, then Ab2 was determined to be in the same bin. As known inthe art this process can be expanded to screen large libraries of uniqueantibodies using a full row of antibodies representing unique bins in a96-well plate. In the instant case this binning process showed thescreened antibodies bound to at least seven different bins on the SEZ6protein. Bins A-F are unique bins and the antibodies contained in eachof these bins compete with each other (but not with antibodies fromother defined bins) for binding to the SEZ6 protein. Bin U containsantibodies that do not compete with antibodies in bins A-F, but maycompete for binding with each other. FIG. 11B shows the correlationbetween the antibodies that bind a certain epitope and the ability ofthose groups of antibodies to kill HEK-293T cells overexpressing SEZ6(described in more detail in Example 10 immediately below).

Example 10 Epitope Mapping of SEZ6 Modulators

In order to characterize the epitopes that the disclosed SEZ6 antibodymodulators associate with or bind to, domain-level epitope mapping wasperformed using a modification of the protocol described by Cochran etal. (J Immunol Methods. 287 (1-2):147-158 (2004)) which is incorporatedherein by reference). Individual domains of SEZ6 were expressed on thesurface of yeast and binding by each SEZ6 antibody was determinedthrough flow cytometry.

Yeast display plasmid constructs were created for the expression of thefollowing constructs: SEZ6 extracellular domain (amino acids 1-904);Sushi Domain 1 (amino acids 336-395), CUB Domain 1 (amino acids297-508), Sushi Domain 2 (amino acids 511-572), CUB Domain 2 (aminoacids 574-685), Sushi Domain 3 (amino acids 690-748), Sushi Domain 4(amino acids 750-813), Sushi Domain 5 (amino acids 817-878), and SushiDomain 5+C-terminus (amino acids 817-904). Additionally, the N terminaldomain (amino acids 1-335) was divided into 3 fragments termed N1 (aminoacids 1-70), N2 (amino acids 71-169) and N3 (amino acids 169-335), eachof which was cloned into the yeast display plasmid. Amino acid numberingdoes not include the 19 amino acid leader peptide. For domaininformation see generally UniProtKB/Swiss-Prot database entry Q53EL9.These plasmids were transformed into yeast, which were then grown andinduced as described in Cochran et al. Note that all amino acidnumbering is based on mature SEZ6 protein without the 19 amino acidleader sequence.

To test for binding to a particular construct, 200,000 induced yeastcells expressing the desired construct were washed twice in PBS+1 mg/mLBSA (PBSA), and incubated in 50 of PBSA with chicken anti c-myc (LifeTechnologies) at 0.1 μg/mL and either 50 nM purified antibody or 1:2dilution of unpurified supernatant from hybridomas cultured for 7 days.Cells were incubated for 90 minutes on ice and then washed twice inPBSA. Cells were then incubated in 50 μL PBSA with the appropriatesecondary antibodies: for murine antibodies, Alexa 488 conjugatedanti-chicken, and Alexa 647 conjugated goat anti-mouse (both LifeTechnologies) were added at 1 μg/mL each, and for humanized or chimericantibodies, Alexa 647 conjugated anti-chicken (Life Technologies) andR-phycoerythrin conjugated goat anti-human (Jackson Immunoresearch) wereadded at 1 μg/mL each. After twenty minutes' incubation on ice, cellswere washed twice with PBSA and analyzed on a FACS Canto II.

All modulators bound uniquely to a single domain expressed on yeastcells. In some cases, antibody clones bound specifically to yeastexpressing Sushi Domain 5+C-terminus but not to yeast expressing SushiDomain 5. These antibody clones were concluded to bind to the C-terminalregion only (amino acids 879-904).

Epitopes were classified either as conformational (i.e. discontinuous)or linear. Yeast displaying the SEZ6 ECD construct was heat treated for30 minutes at 80° C. in order to denature the antigen, washed twice inice-cold PBSA and then subjected to the same staining protocol and flowcytometry analysis as described above. Antibodies that bound to both thedenatured and native yeast were classified as binding to a linearepitope, whereas antibodies that bound native yeast but not denaturedyeast were classified as conformationally specific.

A summary of the domain-level epitope mapping data of the antibodiestested is presented in TABLE 5 below. Antibodies that bind a linearepitope are underlined and antibodies that bind SEZ6 family membersSEZ6L and SEZ6L2 are designated with an asterisk and/or a dagger,respectively.

TABLE 5 Domain Antibody Clones N1 SC17.4, SC17.7 ^(†)*, SC17.9, SC17.56,SC17.81, (aa 1-70) SC17.101, SC17.114, SC17.120, SC17.134, SC17.151,SC17.162, SC17.SC177, SC17.182, SC17.185, SC17.196, SC17.197, SC17.199N2 SC17.24, SC17.49, SC17.104, SC17.144, SC17.149, (aa 71-169) SC17.168,SC17.SC176, SC17.198 N3 SC17.26 ^(†), SC17.42, SC17.83, SC17.85, (aa170-335) SC17.88, SC17.91, SC17.92, SC17.99, SC17.125, SC17.128,SC17.130, SC17.137, SC17.145, SC17.161, SC17.192, SC17.195 Sushi Domain1 SC17.34, SC17.36, SC17.46, SC17.75, SC17.82, (aa 336-395) SC17.87,SC17.97, SC17.116, SC17.129, SC17.SC178, SC17.187, SC17.200 CUB Domain 1SC17.73, SC17.76, SC17.86, SC17.100, SC17.105, (aa 397-508) SC17.107,SC17.1SC17, SC17.122, SC17.124, SC17.136, SC17.138, SC17.146, SC17.154,SC17.SC170, SC17.SC174, SC17.189, SC17.201, SC17.202 Sushi Domain 2SC17.90, SC17.108, SC17.112, SC17.135, SC17.167, (aa 511-572)SC17.SC173, SC17.SC179, SC17.184, SC17.203, SC17.204 CUB Domain 2SC17.6^(†), SC17.28^(†), SC17.103, SC17.109, (aa 574-685) SC17.119,SC17.181, SC17.186, SC17.194 Sushi Domain 3 SC17.72, SC17.84, SC17.95,SC17.141, SC17.143, (aa 690-748) SC17.163 Sushi Domain 4 SC17.SC17,SC17.19 ^(†), SC17.93, SC17.102, (aa 750-813) SC17.121, SC17.140,SC17.156, SC17.159, SC17.166, SC17.SC175, SC17.180, SC17.191, SC17.193Sushi Domain 5 SC17.74, SC17.106, SC17.142, SC17.190 (aa 817-878) Cterminus SC17.96, SC17.132 (aa 879-904)

An interesting and surprising trend was observed when an in vitro cellkilling assay was performed using the domain-mapped SEZ6 antibodymodulators described in this Example 10. The in vitro killing assay,performed essentially as described below in Example 14, determined theability of a particular antibody to internalize and kill HEK-293 cells.FIG. 11B is a plot of efficacy of the tested antibodies versus thedomains to which they bind. Antibodies that bind to certain domainsincluding: N1, N3, Sushi Domain 1, and Sushi Domain 4, exhibitedenhanced in vitro killing. The antibodies that associate with SushiDomain 4, which are very effective at internalizing and killing cells,exhibit a strong correlation with the IGHV1-34 and IKV4-59 murinegermline framework regions.

Fine epitope mapping was further performed on selected antibodies todetermine the specific amino acids to which they bound. Antibodies thatbound to a linear epitope were mapped using the Ph.D.-12 phage displaypeptide library kit (New England Biolabs E8110S). The antibody selectedfor epitope mapping was coated onto a Nunc MaxiSorp tube (Nunc) at 50μg/mL in 3 mL 0.1 M sodium bicarbonate solution, pH 8 and incubatedovernight. The tube was blocked with 3% BSA solution in bicarbonatesolution. Then, 10¹¹ input phage in PBS+0.1% Tween-20 was allowed tobind, followed by ten consecutive washes with 0.1% Tween-20 to wash awaynon-binding phage. Remaining phage were eluted with 1 mL 0.2 M glycinefor 10 minutes at room temperature with gentle agitation, followed byneutralization with 150 μL 1 M Tris-HCl pH 9. Eluted phage wereamplified and panned again with 10¹¹ input phage, using 0.5% Tween-20during the wash steps to increase selection stringency. DNA from 24plaques of the eluted phage from the second round was isolated using theQiaprep M13 Spin kit (Qiagen) and sequenced. Binding of clonal phage wasconfirmed using an ELISA assay, where the mapped antibody or a controlantibody was coated onto an ELISA plate, blocked, and exposed to eachclone phage. Phage binding was detected using horseradish peroxidaseconjugated anti-M13 antibody (GE Healthcare), and the 1-Step Turbo TMBELISA solution (Pierce). Phage peptide sequences from specificallybinding phage were aligned using Vector NTI (Life Technologies) againstthe antigen ECD peptide sequence to determine the epitope of binding.

Selected antibodies that bound to a discontinuous epitope were mappedusing the technique described by Chao et al. (2007). Libraries of SEZ6ECD mutants were generated with error prone PCR using nucleotideanalogues 8-oxo-2′deoxyguanosine-5′-triphosphate and2′-deoxy-p-nucleoside-5′triphosphate (both from TriLink Bio) for atarget mutagenesis rate of one amino acid mutation per clone. These weretransformed into a yeast display format. Using the technique describedabove for domain-level mapping, the library was stained for c-myc andantibody binding at 50 nM. Using a FACS Aria (BD), clones that exhibiteda loss of binding compared to wild type SEZ6 ECD were sorted. Theseclones were re-grown, and subjected to another round of FACS sorting forloss of binding to the target antibody. Using the Zymoprep Yeast PlasmidMiniprep kit (Zymo Research), individual ECD clones were isolated andsequenced. Where necessary, mutations were reformatted as single-mutantECD clones using the Quikchange site directed mutagenesis kit (Agilent).

Individual ECD clones were next screened to determine whether loss ofbinding was due to a mutation in the epitope, or a mutation that causedmisfolding. Mutations that involved cysteine, proline, and stop codonswere automatically discarded due to the high likelihood of a misfoldingmutation. Remaining ECD clones were then screened for binding to anon-competing, conformationally specific antibody. ECD clones that lostbinding to non-competing, conformationally specific antibodies wereconcluded to contain misfolding mutations, whereas ECD clones thatretained equivalent binding as wild type SEZ6 ECD were concluded to beproperly folded. Mutations in the ECD clones in the latter group wereconcluded to be in the epitope. Homology models of isolated domains werealso constructed using MODELLER to confirm that residues identified tobe in the epitope: 1) were localized in close proximity to each other inthe folded homology model, and 2) had side chains that were solventexposed, and not buried, since buried residues would have a higherchance of causing misfolding, and would unlikely be part of the epitopeof binding. A summary of antibodies with their epitopes are listed inTable 6. The residues found to most significantly contribute to thestructure of the epitope are underlined.

TABLE 6 Antibody Discon- SEQ Clone Epitope tinuous ID NO: SC17.4 Q12,P14, I16, E17, E18 No 401 SC17.17 R762, L764, Q777, I779, D781, Q782 YesNR SC17.24 L73, P74, F75, Q76, P77, D78, P79 No 402 SC17.34 T352, S353,H375 Yes NR SC17.36 T352, S353, H375, S359 Yes NR SC17.46 R342, K389 YesNR SC17.102 R762, L764, Q777, I779, D781, Q782 Yes NR SC17.121 R762,L764, Q777, I779, D781, Q782 Yes NR SC17.140 R762, L764, Q777, I779,D781, Q782 Yes NR SC17.156 R807, K810 Yes NR SC17.166 R762, L764, Q777,I779, D781, Q782 Yes NR SC17.191 R762, L764, Q777, I779, D781, Q782 YesNR SC17.200 T352, S353, H375 Yes NR

NR indicates that a SEQ ID NO was not assigned as the epitopes werediscontinuous.

For the purpose of fine epitope mapping of SC17.34, SC17.36, SC17.200and SC17.46, point mutations were constructed on the isolated domain,Sushi Domain 1, which was determined to be the domain of binding bydomain-level epitope mapping. In some cases, candidate mutations forscreening were determined independently of the yeast displayed library.For example, in the case of SC17.46, candidate mutations for screeningwere not identified in a library-based screen; rather they wereidentified on the basis of domain mapping, lack of cross reactivity tocynomolgus SEZ6 ECD and rat SEZ6 ECD, and sequence alignments of thedifferent species to identify differences in the species' primarysequence. In the case of SC17.102, SC17.121, SC17.140, SC17.156,SC17.166, SC17.191, and 17.200, candidate residues were identified usinga combination of alanine scanning, and domain binding analysis. In allcases, candidate mutations were subjected to the same analysis as otherantibodies whose candidate mutations were identified by a library basedapproach.

The present invention is directed to anti-SEZ6 antibodies and antibodydrug conjugates that bind to an epitope on a SEZ6 protein (including,for example, a SEZ6 protein of SEQ ID NO: 3 or 4), wherein the epitopecomprises amino acid residues selected from the group consisting of (i)residues Q12, P14, I16, E17, E18; (ii) residues R762, L764, Q777, I779,D781, Q782; (iii) residues L73, P74, F75, Q76, P77, D78, P79; (iv)residues T352, S353, H375; (v) residues T352, S353, H375, S359; (vi)residues R342, K389; (vii) residues R762, L764, Q777, I779, D781, Q782;or (viii) residues R807, K810. In one embodiment, the invention isdirected to anti-SEZ6 antibodies and antibody drug conjugates that bindto an epitope on a SEZ6 protein (including, for example, a SEZ6 proteinof SEQ ID NO: 3 or 4), wherein the epitope comprises amino acid residuesselected from the group consisting of (i) residues Q12, P14, I16, E17,E18; (ii) residues R762, L764, Q777, I779, D781, Q782; (iii) residuesL73, P74, F75, Q76, P77, D78, P79; (iv) residues T352, S353, H375; (v)residues T352, S353, H375, S359; (vi) residues R342, K389; (vii)residues R762, L764, Q777, I779, D781, Q782; or (viii) residues R807,K810. In another embodiment the invention is directed to anti-SEZ6antibodies or antibody drug conjugates that bind to the same epitope ona SEZ6 protein (including, for example, a SEZ6 protein of SEQ ID NO: 3or 4) as any one of the following antibodies: SC17.4, SC17.17, SC17.24,SC17.34, SC17.36, SC17.46, SC17.102, SC17.121, SC17.140, SC17.156,SC17.166, SC17.191 and SC17.200.

Example 11 Detection of SEZ6 Surface Expression by Flow Cytometry

Flow cytometry was used to assess the specificity of the anti-SEZ6antibodies that were generated for detecting the presence of human SEZ6protein on the surface of engineered HEK-293T cell lines, constructed asdescribed in Example 5. Isotype-stained and fluorescence minus one (FMO)controls were employed to confirm staining specificity. Briefly,HEK-293T transduced with human SEZ6 and GFP (see Example 5) or harvestedNTX tumor samples were dissociated and dispersed into suspension usingart-recognized enzymatic digestion techniques (see, for example,U.S.P.N. 2007/0292414 which is incorporated herein), were incubated for30 minutes with an anti-SEZ6 antibody. Cells were washed in PBS (2% FCS)twice and then incubated with 50 μl per sample DyLight 649 labeledgoat-anti-mouse IgG, Fc fragment specific secondary diluted 1:200 in PBSbuffer. After a 15 minute incubation cells were washed twice with PBSand re-suspended in PBS with DAPI and analyzed by flow cytometry aspreviously discussed.

As demonstrated by the representative data shown in FIG.12A for SC17.33,the SEZ6 modulator strongly recognized HEK-293T-HuSEZ6 cells. These datademonstrate that modulators were produced that specifically recognizedhuman SEZ6 expressed on the cell surface.

Human SEZ6 protein expression on the surface of selected NTX tumors wasassessed by flow cytometry using several exemplary SC17 antibodies. Theexpression of SEZ6 in LU37, LU86 and KDY66 was tested using the SC17.6(duplicate of SC17.16) antibody while expression of SEZ6 in LU50, LU100and LU73 was tested using the SC17.10, SC17.42 and SC17.28 antibodiesrespectively. The results are set forth in FIG. 13A. NTX tumors wereharvested, dissociated, and co-stained with commercially availableanti-mouse CD45, anti-mouse H-2Kd, anti-human EpCAM and one theabove-described mouse anti-human SEZ6 antibodies. Data shown in FIG. 13Awas generated using cells that did not stain positively for the abovementioned anti-mouse antibodies but did stain positively for anti-humanEpCAM. Similar to the HEK-293T-staining experiments described above,isotype-stained and fluorescence minus one (FMO) controls were employedto confirm staining specificity. As seen in FIG. 13A, anti-SEZ6 stainingwas higher than FMO in all of the human NTX tumor cells, as indicated bythe fluorescent profile shift to the right, and by changes in the meanfluorescence intensity (MFI) values, for the lung NTX tumors LU37, LUSOand LU86 and kidney NTX tumor, KDY66. These data suggest that the SEZ6protein is expressed on the surface of various NTX tumors and thereforeamenable to modulation using an anti-SEZ6 antibody.

Example 12 Expression of SEZ6 Protein in Various Tumors

Given the elevated SEZ6 mRNA transcript levels associated with varioustumors, work was undertaken to demonstrate a corresponding increase inthe expression of SEZ6 protein in NTX tumors. SEZ6 protein expressionwas detected with (i) an electrochemiluminscence SEZ6 sandwich ELISAassay using the MSD Discovery Platform (Meso Scale Discovery, LLC); and(ii) immunohistochemistry staining.

NTX tumors were excised from mice and flash frozen on dry ice/ethanol.Protein Extraction Buffer (Biochain Institute, Inc.) was added to thethawed tumor pieces and tumors were pulverized using a TissueLysersystem (Qiagen). Lysates were cleared by centrifugation (20,000 g, 20minutes, 4° C.) and the total protein concentration in each lysate wasquantified using bicinchoninic acid. Protein lysates were stored at −80°C. until assayed. Normal tissue lysates were purchased from a commercialsource.

SEZ6 protein concentrations from the lysate samples were determined byinterpolating the values from a standard protein concentration curvethat was generated using purified recombinant SEZ6 protein (Example 5).The SEZ6 protein standard curve and protein quantification assay wereconducted as follows:

MSD standard plates were coated overnight at 4° C. with 30 μL of SC17.17antibody at 2 μg/mL in PBS. Plates were washed in PBST and blocked in150 μL MSD 3% Blocker A solution for one hour. Plates were again washedin PBST. 25 μL of 10× diluted lysate in MSD 1% Blocker A or seriallydiluted recombinant SEZ6 standard in MSD 1% Blocker A containing 10%Protein Extraction Buffer was also added to the wells and incubated fortwo hours. Plates were washed in PBST. The SC17.36 antibody was thenconjugated to the MSD sulfo-tag and 25 μL of the tagged SC17.36 wasadded to the washed plates at 0.5 μg/mL in MSD 1% Blocker A. MSD ReadBuffer T with surfactant was diluted to 1× in water and 150 was added toeach well. Plates were read on a MSD Sector Imager 2400 using anintegrated software analysis program to derive SEZ6 concentrations inNTX samples via interpolation from the standard curve. Values were thendivided by total protein concentration to yield nanograms of SEZ6 permilligram of total lysate protein. The resulting concentrations are setforth in FIG. 12B wherein each spot represents SEZ6 proteinconcentrations derived from a single NTX tumor line. While each spot isderived from a single NTX line, in most cases multiple biologicalsamples were tested from the same NTX line and values were averaged toprovide the data point.

FIG. 12B shows that compared to normal tissue lysates, selected kidney,ovarian and LCNEC tumor samples exhibited moderate SEZ6 proteinexpression whereas the highest SEZ6 protein expression was seen in SCLCtumors. All normal tissue lysates were negative for SEZ6 proteinexpression with the exception of normal human brain and eye lysate.

Immunohistochemistry (IHC) was performed on PDX tumors to confirm thatSEZ6 is expressed on the surface of certain PDX tumors; and in order todetermine the location of the SEZ6 protein in the tumor architecture.IHC was performed on formalin fixed paraffin embedded (FFPE) tissuesections using an indirect detection method which included murinemonoclonal primary antibody against SEZ6 (SC17.140), mouse specificbiotin conjugated secondary antibodies, avidin/biotin complex coupledwith horse radish peroxidase, and DAB detection (Nakene PK 1968;16:557-60). SC17.140 was validated and confirmed to be appropriate forIHC by showing specific staining on FFPE sections of HEK-293T cellpellets overexpressing SEZ6 compared to naive HEK-293T cell pellets,prepared as described in Example 5. Specificity was further confirmed bycompeting signal with a 5 molar excess of purified recombinant SEZ6 onHEK-293T cells overexpressing human SEZ6 and NTX tumors that were shownby IHC to express SEZ6 (data not shown).

SEZ6 expression was measured by IHC in SCLC NTX tumors, where 13 out ofthe 14 SCLC NTX tumors tested, expressed SEZ6 (FIG. 16A). Additional IHCanalysis was performed on five tissue microarrays (TMA) generated usingcored sections of 174 human tumors resected from SCLC patients(Vanderbilt University, Memorial Sloan Kettering Cancer Center andBiomax, Inc.). FIG. 16B shows SEZ6 expression measured by IHC in 174primary patient SCLC tumors included in those five TMAs, wherein 122/174of the SCLC samples, 2/3 SCLC/Adenocarcinoma samples and 1/1SCLC/Spindle Cell samples were shown to express SEZ6. In contrast, thenormal lung tissue samples that were tested did not express SEZ6 (FIG.16B). The IHC results shown in FIGS. 16A and 16B were analyzed with anautomated image analysis software package (Leica Biosystems) thatquantifies the intensity of cell surface staining and provides a final“H-Score”, which reflects the percentage of tumor cells stained at eachintensity level (0 for no staining and 3 for intense staining). TheH-Score is calculated as follows: (% at 0)*0+(% at 1+)*1+(% at 2+)*2+(%at 3+)*3. Thus, the H-Score produces a continuous variable that rangesfrom 0 to 300.

IHC was also performed on FFPE sections from patients with medullarythyroid cancer. All of the patient samples that were tested were shownto express SEZ6 (FIG. 16C). The thyroid cancer samples were scoredmanually with a (-) for no expression, and a (+, ++ or +++) to denoteincreasing intensity of staining. The percentage of tumor cells in theFFPE section estimated to express SEZ6, is also shown in FIG. 16C.

RNA in situ hybridization (ISH) was used to verify the results of SEZ6expression determined by IHC described immediately above. ISH wasperformed manually using an RNAscope® 2.0 Reagent Kit (Advanced CellDiagnostics; Wang et al, 2012, PMID: 22166544). The RNAscope probe thatwas used was specific to the ECD of SEZ6. Each sample was qualitycontrolled for RNA integrity with an RNAscope probe specific toPeptidylprolyl Isomerase B (PPM), a cyclosporine-binding protein locatedwithin the endoplasmic reticulum of all cells. Background staining wasdetermined using a probe specific to DiAminoPimelate (dapB) RNA.Briefly, 5 μm FFPE tissue sections from 3 of the SCLC tumor microarraythat was used in FIG. 16B, were pretreated with heat and protease priorto hybridization with the SEZ6 RNA oligonucleotide probes. Preamplifier,amplifier and HRP labeled oligonucleotides were then hybridizedsequentially, followed by chromogenic precipitate development with3,3′-diaminobenzidine. Specific RNA staining signal was identified asbrown, punctate dots. Samples were counterstained with Gill'sHematoxylin. FFPE sections were analyzed under a light microscope andstaining was scored manually on a scale of 0 to 4, where 0=no stainingor less than 1 dot per 10 cells; 1=1-3 dots per cell; 2=4-10 dots percell; 3=more than 10 dots per cell and less than 10% dots found inclusters. In addition, a score of 0.5 was given if, for example, 5-30%of cells in a sample had a score of 1 and more than 70% of the cells hada score of 0. Of the tumor samples tested 5/32 (16%) did not expressSEZ6; 17/32 (53%) had a score of 1; 8/32 (25%) had a score of 2 and 2/32(6%) had a score of 3. Overall 84% of primary patient SCLC samples inthe tissue microarrays expressed SEZ6 RNA at some level. This is largelyin agreement with the results obtained from IHC.

The data, combined with the mRNA transcription data for SEZ6 expressionset forth in Example 4, and cell surface protein expression of SEZ6 setforth in Example 11, strongly reinforces the proposition that SEZ6determinants provide attractive targets for therapeutic intervention.

Example 13 Enrichment of Tumor Initiating Cell Populations

Tumor cells can be divided broadly into two types of cellsubpopulations: non-tumorigenic cells (NTG) and tumor initiating cells(TICs). TICs have the ability to form tumors when implanted intoimmunocompromised mice. Cancer stem cells (CSCs) are a subset of TICsand are able to self-replicate indefinitely while maintaining thecapacity for multilineage differentiation. To determine whether SEZ6expression could be correlated with enhanced tumorigenicity wholetranscriptome sequencing, flow cytometry and a tumorigenicity assay wereperformed, all of which are described below.

Whole transcriptome analysis of SEZ6 expression in various tumor sampleswas performed as described in Example 1. CSCs were identified on thebasis of expression of CD324 which has been shown to be a marker of stemcells in various tumors (see PCT application 2012/031280). The resultsin FIG. 6B show that SEZ6 mRNA expression was elevated in CSCs comparedto NTG cells isolated from two SCLC NTX tumor lines (LU86 and LU95).

Flow cytometry was performed on cells from NTX lung tumors essentiallyas described in Example 11. LU86, LU117 and LU64 cells were co-stainedwith CD324, a marker of CSC populations (see PCT application2012/031280), and the anti-SEZ6 antibody, SC17.10, SC17.28 or SC17.42,respectively to determine if SEZ6 is differentially expressed on thesepopulations. As indicated in FIG. 13B, LU86, LU117 and LU64 cellsstaining positive for both CD324 and SEZ6 (solid black line) shiftfurther to the right compared to cells staining positive for SEZ6 alone(dotted black line), indicating that SEZ6 is more highly expressed onCSCs compared to the NTG cell population. The bulk population isotypecontrol is shown as a gray filled histogram (MOPC=IgG1).

To determine whether cell surface SEZ6 expression could be correlatedwith enhanced ability to generate tumors, a tumorigenicity study wasconducted. NTX tumor samples were dissociated and dispersed intosuspension using art-recognized enzymatic digestion techniques (see, forexample, U.S.P.N. 2007/0292414 which is incorporated herein). Thedissociated cell preparations from these NTX lines were stained withfluorescently conjugated antibodies specifically recognizing murineCD45, H2kD, human CD324, and human SEZ6, clone SC17.42. Two subsets ofhuman cells, both identified based on the absence of staining withmurine CD45 or H2kD (to deplete the cell preparations of murine cells)were isolated using a FACSAria™ Flow Cytometer (BD Biosciences). Onesubset was isolated on the basis of a CD324 and SEZ6 co-expression,while the other subset was isolated on the basis of a CD324⁺SEZ6⁻phenotype. The distinct marker-enriched subpopulations were subsequentlytransplanted into female NOD/SCID immunocompromised mice by subcutaneousinjection into the mammary fat pad at a dose of approximately 50 cellsper mouse.

FIGS. 14A and 14B illustrate the results of such experiments conductedusing representative NTX cell lines derived from NSCLC tumors obtainedfrom patients. FIG. 14A is a scatter plot (gated using CD324 and SEZ6)showing the distribution of mCD45⁻H2kD⁻ subset of the parent tumor andsorted putative tumorigenic cells. FIG. 14B graphically shows themeasured tumor volume arising from the implantation of sorted cellsubpopulations into immunocompromised mice. Values in parenthesisindicate the number of tumors generated per mice implanted.

Significantly, the data from FIG. 14 show that tumorigenicity wasconsistently associated with the subpopulation of cells expressing SEZ6in combination with high levels of CD324. Conversely, these same datademonstrate that tumor cells expressing either no, or low levels of SEZ6were much less tumorigenic than their high or positive counterparts.Based on the generated data it was surprisingly found thatsubpopulations of tumor cells expressing the CD324⁺SEZ6⁺ phenotypegenerally contain the vast majority of tumorigenic capability andsuggest that SEZ6 may provide an effective therapeutic target fortumorigenic cell modulation.

Example 14 SEZ6 Modulators Facilitate Delivery of Cytotoxic Agents toSEZ6-Expressing HEK-293T Cells

To demonstrate that SEZ6 modulators of the instant invention are able tomediate the delivery of a cytotoxic agent to live cells, an in vitrocell killing assay was performed using selected SEZ6 antibody modulatorsbound to a saporin toxin. Saporin kills cells by deactivating ribosomesin the cytoplasm. Thus cell death using the following assay is anindication that the SEZ6 antibodies are able to internalize and delivercytotoxic agents to the cytoplasm of a target cell.

An anti-Mouse IgG Fab fragment covalently linked to saporin(“Fab-Saporin”)

(Advanced Targeting Systems, #IT-48) was combined with unlabeled SEZ6antibodies and incubated with HEK-293T cells expressing human SEZ6 (seeExample 5). The ability of the resulting saporin complexes tointernalize and kill cells was measured 72 hours later by measuring cellviability.

Specifically, 500 cells per well in DMEM supplemented with 10% fetalbovine serum, were plated into 96 well tissue culture treated plates oneday before the addition of antibodies and toxin. HEK-293T cellsexpressing human SEZ6 were treated with a control (IgG1, IgG2a or IgG2b)or purified murine SEZ6 modulators at a concentration of 100, 50 or 10pM, together with 2 nM Fab-Saporin. The cells were cultured for threedays, after which, viable cell numbers were enumerated using Cell TiterGlo® (Promega) as per manufacturer's instructions. Raw LuminescenceUnits (RLU) using cultures containing cells with the Saporin Fabfragment were set as 100% reference values and all other countscalculated accordingly (referred to as Normalized RLU or “% livecells”). FIG. 15A shows that many of the SEZ6 modulators tested mediatedthe killing of HEK-293T cells in a concentration dependent manner.Isotype controls (IgG2a, IgG2b, and IgG1) did not affect cell counts asshown by the results in the first three rows of FIG. 15A (ND=NotDetermined).

This assay demonstrates that internalization may occur upon binding ofthe SEZ6-specific antibody to the cell surface, without the need foradditional crosslinking or dimerization.

Example 15 SEZ6 Modulators Mediate Cytotoxicity in Lung Tumor Cells InVitro

To corroborate the results of Example 14 and determine whether SEZ6modulators can mediate toxin internalization and cell killing of humantumor cells (as opposed to engineered cells), mouse lineage-depleted NTXcells were plated and subsequently exposed to anti-SEZ6 antibodies andFab-saporin.

NTX tumors were dissociated into a single cell suspension and plated onPrimaria™ plates (BD Biosciences) in growth factor supplemented serumfree media as is known in the art. After culturing the cells for one dayat 37° C./5% CO₂/5% O₂, they were treated with a control (IgG1, IgG2a orIgG2b) or a murine SEZ6 modulator and Fab-saporin as described inExample 14. After seven days, the modulator-mediated saporincytotoxicity was assessed by quantifying the remaining number of livecells using Cell Titer Glo.

As seen in FIG. 15B a reduction in the number of tumor cells was evidentwhen LU37, a NSCLC tumor and LU80, a SCLC tumor were exposed to SC17.6(duplicate sequence of SC17.16) and SC17.33 SEZ6 modulators. Similarlywhen LU100, a SCLC tumor was exposed to four SEZ6 modulators, SC17.6,SC17.19, SC17.33 and SC17.34, at 50 and 500 pM a reduction of tumorcells was effected. In contrast, isotype control antibodies did notimpact the number of live cells after treatment.

Not only does this data demonstrate that exemplary antibodies describedherein are able to bind SEZ6 antigen on the cell surface and facilitatethe delivery of a cytotoxic payload resulting in cell death, but theabove data also demonstrated that multiple anti-SEZ6 antibodies canmediate killing of various NTX tumor cells.

Example 16 Preparation of SEZ6 Antibody-Drug Conjugates

Based on the in vitro killing assays with saporin in Examples 14 and 15and to further demonstrate the versatility of the instant invention,anti-SEZ6 antibody drug conjugates were prepared having the M-[L-D]structure as described above. That is, anti-SEZ6 antibody drugconjugates (SEZ6-ADCs) were prepared using covalently linked cytotoxicagents. More specifically, SEZ6-ADCs were prepared comprising a linkeras described herein, or in the references immediately below, andselected pyrrolobenzodiazepine (PBD) dimers that were covalentlyattached to the disclosed modulators (see, e.g., U.S.P.Ns. 2011/0256157and 2012/0078028 and U.S. Pat. No. 6,214,345 each of which isincorporated herein by reference in its entirety).

PBD drug-linker combinations were synthesized and purified usingart-recognized techniques in view of the cited references. While variousPBD dimers and linkers were employed to fabricate the selecteddrug-linker combinations, each linker unit comprised a terminalmaleimido moiety with a free sulfhydryl. Using these linkers,conjugations were prepared via partial reduction of the mAb with tris(2-carboxyethyl)-phosphine (TCEP) followed by reaction of reduced Cysresidues with the maleimido-linker payload.

More particularly, the selected SEZ6 antibody modulator was reduced with1.3 mol TCEP per mol mAb for 2 hr at 37° C. in 25 mM Tris HCl pH 7.5 and5 mM EDTA buffer. The reaction was allowed to cool to 15° C. and thelinker payload in DMSO was added at a ratio of 2.7 mol/mol mAb followedby an additional amount of DMSO to a final concentration of 6% (v/v).The reaction was allowed to proceed for 1 hour. The unreacteddrug-linker was capped by addition of an excess of N-acetyl cysteine.The SEZ6-ADC (or SC17-ADC) was then purified by ion exchange columnusing an AKTA Explorer FPLC system (G.E. Healthcare) to removeaggregated high molecular weight antibody, co-solvent and smallmolecules. The eluted ADC was then buffer-exchanged by tangential flowfiltration (TFF) into formulation buffer followed by concentrationadjustment and addition of a detergent. The final ADC was analyzed forprotein concentration (by measuring UV), aggregation (SEC), drug toantibody ratio (DAR) by reverse phase (RP) HPLC, presence ofunconjugated antibody by hydrophobic interaction chromatography (HIC)HPLC, non-proteinaceous materials by RP HPLC and in vitro cytotoxicityusing a SEZ6 expressing cell line.

Using the aforementioned procedure, or substantially similarmethodology, a number of ADCs (i.e., M-[L-D]n) comprising various SEZ6modulators and PBD dimers were generated and tested in a variety of invivo and in vitro models. For the purposes of these Examples and theinstant disclosures, such ADCs may generally be termed SEZ6-ADCs orSC17-ADCs. Discrete ADCs will be named according to the antibody (e.g.,SC17.17) and the specific linker-cytotoxic agent designation ADC1, ADC2,etc. Thus, exemplary modulators compatible with the instant inventionmay comprise SC17.17-ADC1 or SC17.24-ADC2 where ADC1 and ADC2 representindividual PBD dimer cytotoxic agents (and optionally a linker).

As an initial benchmark, the in vitro cytotoxicity of hSC17.17-ADC1 wasmeasured at an IC50 of 11 nM when exposed to HEK293 cells overexpressingSEZ6 (data not shown).

Example 17 Conjugated SEZ6 Modulators Mediate Cytotoxicity in Lung andOvarian Tumor Cells In Vitro

The ADCs generated in Example 16 above were tested to determine whetherthey were able to mediate toxin internalization and cell killing ofprimary human tumor cells in vitro.

Mouse lineage-depleted NTX tumor cells were exposed to anti-SEZ6 ADCs ora mouse isotype control (msIgG1) using the same method as described inExample 15, except that Fab-saporin was not added. When LU64, a SCLCtumor and OV26, a NET ovarian tumor, were treated with anti-SEZ6 ADCs(SC17.24-ADC2, SC17.28-ADC2 and SC17.34-ADC2), an increased reduction inpercent viable cells was observed compared to the control msIgG1 (FIG.17A). While msIgG1 can be cytotoxic to cells at high concentrations, allthree anti-SEZ6 ADCs tested were more potent, indicating animmunospecific response to SEZ6 rather than a general response to thePBD cytotoxin.

Example 18 Conjugated SEZ6 Modulators Suppress Tumor Growth In Vivo

The ADCs generated in Example 16 above were tested to demonstrate theirability to shrink and suppress human NTX tumor growth in immunodeficientmice.

Patient-derived NTX tumors were grown subcutaneously in the flanks offemale NOD/SCID recipient mice using art-recognized techniques. Tumorvolumes and mouse weights were monitored twice per week. When tumorvolumes reached 150-250 mm³, mice were randomly assigned to treatmentgroups and injected intraperitoneally with SC17-ADC1 or a controlMsIgG1-ADC1. Mice were given three injections of 1 mg/kg (indicated bythe vertical lines in FIG. 17B) over a period of seven days. Followingtreatment, tumor volumes and mouse weights were monitored until tumorsexceeded 800 mm³ or mice became sick.

FIG. 17B shows that murine anti-SEZ6 ADCs are able to inhibit in vivogrowth of a SCLC tumors (e.g. LU86) and a LCNEC tumors (e.g. LUSO) inmice. In the case of LU86 the five ADCs tested (SC17.3-ADC1,SC17.24-ADC1, SC17.26-ADC1, SC17.28-ADC1 and SC17.34-ADC1) produceddurable remissions lasting, in some cases, beyond 120 dayspost-treatment. In particular, SC17.34-ADC1 treatment inhibited tumorgrowth for the duration of the study at this dose, while SC17.24-ADC1led to significant tumor growth inhibition with time to progression ofgreater than 50 days. Similarly, treatment of LUSO with five exemplaryADCs (SC17.3-ADC1, SC17.17-ADC1, SC17.24-ADC1, SC17.34-ADC1 andSC17.46-ADC1) resulted in tumor growth suppression lasting as long as 35days with SC17.46. Moreover, mice treated with SC17-ADC1 did not exhibitadverse health effects beyond those typically seen in immunodeficient,tumor-bearing NOD/SCID mice. These results suggest that the disclosedADCs may be used to effectively suppress tumor growth and that theparticulars of SC17 modulator binding can have an impact on in vivoefficacy.

More directly the ability of a variety of conjugated modulators todramatically retard or suppress tumor growth in vivo for extendedperiods further validates the use of SEZ6 as a therapeutic target forthe treatment of proliferative disorders.

Example 19 Humanized Conjugated SEZ6 Modulators Suppress Tumor Growth

Given the impressive results obtained with murine anti-SEZ6 ADCmodulators, additional experiments were performed to demonstrate theefficacy of exemplary humanized anti-SEZ6 ADC modulators in treating athyroid cancer cell line in vitro and in vivo and SCLC tumors in vivo.

A thyroid cancer cell line was purchased (ATCC, CRL-1803) and plated at500 cells per well in a 96 well plate in F-12K Medium (ATCC; Catalog#30-2004) supplemented with 10% fetal bovine serum (FBS) at 37° C. 5 nMof either hSC17.200-ADC1, produced as set forth in Example 16, orcontrol IgG1-ADC1 were added to the cells. After 8 days viable cellnumbers were enumerated using Cell Titer Glo® (Promega) as permanufacturer's instructions. Efficacy was measured using RawLuminescence Units (RLU), where the RLU of untreated cells were set as100% reference values and all other RLU values were calculated relativeto the reference values (referred to as Normalized RLU). The results inFIG. 18A show that the anti-SEZ6 antibody drug conjugate, hSC17.200-ADC1suppressed the growth of thyroid cancer cells significantly more thanthe human IgG1-ADC1 control.

The ability of humanized anti-SEZ6 ADCs to reduce medullary thyroidtumor volumes in vivo was also tested. A thyroid cell line (ATCC,CRL-1803) was cultured in a 96 well plate at 500 cells per well in F-12KMedium supplemented with 10% FBS at 37° C. Cells were harvested andimplanted subcutaneously in five NOD/SCID mice. Once the tumors in themice reached an average of 200 mm³ a single dose of 2 mg/kghSC17.200-ADC1 was administered via intraperitoneal injection. Efficacywas monitored by weekly tumor volume measurements, with mean tumorvolumes and standard error mean (SEM) plotted versus time (days).Following administration of hSC17.200-ADC1 a significant reduction intumor volume was observed (FIG. 18B).

The ability of humanized anti-SEZ6 ADCs to reduce SCLC tumor volume wasalso tested. Anti-SEZ6 ADCs (hSC17.17, hSC17.24, hSC17.34 and hSC17.46),and the human IgG1 isotype control ADC (huIgG1) were administered toimmunodeficient mice bearing various patient derived NTX tumors. Micewere given three injections of 1 mg/kg (indicated by the vertical linesin FIGS. 18C and 18D) over a period of seven days. Following treatment,tumor volumes and mouse weights were monitored until tumors exceeded 800mm³ or mice became sick. The results of these experiments are presentedin FIGS. 18C and 18D. Complete and durable elimination of tumor mass wasachieved by the administration of humanized anti-SEZ6 ADCs in four SCLCtumors. FIG. 18C shows reduction of the LU80 tumor by hSC17.17-ADC1 andhSC17.46-ADC1; and elimination of the LU64 tumor by hSC17.17-ADC1,hSC17.34-ADC1 and hSC17.46-ADC1. FIG. 18D shows reduction of the LU117tumor by hSC17.17-ADC1 and hSC17.46-ADC1; and reduction of the LU111tumor by hSC17.34-ADC1 and hSC17.46-ADC1.

These results demonstrate the surprising applicability of a variety ofhumanized SEZ6 modulators to effectively retard the growth of differenttumors.

Example 20 Generation of a Chemoresistant PDX Cell Line

A chemoresistant SCLC line was generated to test the expression of SEZ6in tumors that had already undergone a first line of chemotherapeutictreatment. The chemoresistant cell line was developed from a SCLCpatient-derived xenograft (PDX) tumor cell line obtained from a PDXtumor bank that was generated and maintained using art-recognizedtechniques. The PDX tumor bank comprises a substantial number ofdiscrete tumor cell lines that were propagated in immunocompromised micethrough multiple passages of heterogeneous tumor cells originallyobtained from numerous cancer patients afflicted by a variety of solidtumor malignancies. The passage number of the tested sample is indicatedby p0-p# where p0 is indicative of an unpassaged sample obtaineddirectly from a patient tumor and p# is indicative of the number oftimes the tumor has been passaged through a mouse prior to testing.Early passage PDX tumors respond to therapeutic agents such asirinotecan (i.e. Camptosar®) and cisplatin/etoposide regimens, providingclinically relevant insights into underlying mechanisms driving tumorgrowth, resistance to current therapies and tumor recurrence.

Cisplatin and its derivatives, including oxaliplatin are thechemotherapeutic standard of care for SCLC. An oxaliplatin-resistantSCLC PDX line was developed due to concerns that cisplatin may not bestable in tissue culture medium (Schuldes et al., 1997, PMID: 9128988).The oxaliplatin-resistant SCLC line was generated by isolating humancells from LU124p2, a SCLC PDX line that had been passagedsubcutaneously twice through NOD.SCID mice. LU124p2 tumors were resectedfrom mice after reaching 800-2,000 mm³, dissociated into single cellsuspensions using art-recognized enzymatic digestion techniques (see,for example, US2007/0292414), and depleted of murine cells. The cellswere then washed and cultured in 5% oxygen and serum-free medium andimmediately treated with 1 μM of oxaliplatin. After seven days ofexposure to oxaliplatin, the cells were washed and allowed to recoverfor two weeks in standard serum-free media with fresh renewal of mediumtwice a week. After the recovery period, the cells were washed andre-plated into a new flask with 1 μM of oxaliplatin for seven more days,followed by a final wash and a two week recovery period. The resultingcell line was termed LU124OXAHIp2. Single cell suspensions weregenerated using Versene (Invitrogen). Some of the cells were injectedinto mice to propagate the LU124OXAHIp2 cell line, while other cellswere cultured in vitro to test sensitivity to oxaliplatin. Oxaliplatinsensitivity of LU124OXAHIp2 was tested as follows: LU124OXAHIp2 cellswere plated onto 96-well plates and treated with a titration ofoxaliplatin in serum-free medium as is standard in the art. After sevendays in culture, cells were harvested using Cell Titer Glo® (Promega) asper the manufacturer's instructions and dose response curves wereobtained. LU124OXAHIp2 was more resistant to higher doses of oxaliplatin(IC₅₀=2-2.5 μM) compared to the parental cell line (LU124p2) (IC₅₀=0.036μM) (FIG. 19). To determine whether the resistance was stable,LU124OXAHIp2 cells were passaged again through immunocompromised mice toyield the cell line called LU124OXAHIp3. Resistance was maintained inLU124OXAHIp3, which shows that even in the absence of selective pressurei.e. even when oxaliplatin is absent, resistance of the cell line wasmaintained.

Example 21 SEZ6 Expression in Chemoresistant Tumor Cells UsingMicroarray

Microarray expression profiling was used to identify potential cellsurface targets that were upregulated on LU124OXAHIp3 compared to thechemo-sensitive parental line. In preparation for the assay, tumors fromthe LU124p3 and LU124OXAHIp3 PDX lines were resected, dissociated intosingle cell suspensions and depleted of murine cells as described inExample 1. The cells were lysed in RLTplus RNA lysis buffer per themanufacturer's instructions, stored at −80° C. and thawed for mRNAextraction. Upon thawing total mRNA was extracted using an RNeasyisolation kit (Qiagen) and quantified using a Nanodrop spectrophotometer(Thermo Scientific) and/or a Bioanalyzer 2100 (Agilent Technologies),using the manufacturer's protocols and recommended instrument settings.The resulting total mRNA preparations were assessed for suitability forgenetic sequencing and gene expression analysis.

1-2 μg of whole tumor total mRNA samples were analyzed using the AgilentSurePrint GE Human 8x60 v2 microarray platform which contains 50,599biological probes designed against 27,958 genes and 7,419 lncRNAs in thehuman genome. Standard industry practices were used to normalize andtransform the intensity values to quantify gene expression for eachsample. SEZ6 mRNA (Agilent probe ID: A_23_P49849) was identified asbeing upregulated in LU124OXAHIp3 compared to the matched parental line,LU124p3, and also the parental line from an earlier murine passage,LU124p1 (FIG. 20).

Example 22 SEZ6 Protein Expression in a Chemoresistant Tumor Cell Line

Given the elevated SEZ6 mRNA transcript levels associated with theoxaliplatin-resistant cell line generated as described in Example 1,work was undertaken to test whether SEZ6 protein expression was alsoelevated in that cell line. To detect and quantify SEZ6 proteinexpression, an electrochemiluminscence SEZ6 sandwich ELISA assay wasdeveloped using the MSD Discovery Platform (Meso Scale Discovery).

LU124p3 cells and LU124OXAHIp3 cells were flash frozen on dryice/ethanol. Protein Extraction Buffer (Biochain Institute) was added tothe thawed cells, lysates were cleared by centrifugation (20,000 g, 20minutes, 4° C.) and the total protein concentration in each lysate wasquantified using bicinchoninic acid. Protein lysates were stored at −80°C. until assayed. SEZ6 protein concentrations from the lysate sampleswere determined by interpolating the values from a standard proteinconcentration curve that was generated using purified recombinant SEZ6protein. The SEZ6 protein standard curve and protein quantificationassay were conducted as follows:

MSD standard plates were coated overnight at 4° C. with 30 μL of theanti-SEZ6 antibody SC17.17 at 1 μg/mL in phosphate buffered saline(PBS). Plates were washed in PBST and blocked in 150 μL MSD 3% Blocker Asolution for one hour while shaking. Plates were again washed in PBST.25 μL of 10x diluted lysate (or serially diluted recombinant SEZ6standard) in MSD 1% Blocker A containing 10% Protein Extraction Bufferwas also added to the wells and incubated for two hours while shaking.Plates were again washed in PBST. The anti-SEZ6 antibody SC17.36antibody was sulfo-tagged and 25 μL of the tagged SC17.36 antibody wasadded to the washed plates at 0.5 μg/mL in MSD 1% Blocker A for 1 hourat room temperature while shaking. Plates were washed in PBST. MSD ReadBuffer T with surfactant was diluted to 1× in water and 150 μL was addedto each well. Plates were read on an MSD Sector Imager 2400 using anintegrated software analysis program to derive SEZ6 concentrations inPDX samples via interpolation from the standard curve. Values were thendivided by total protein concentration to yield nanograms of SEZ6 permilligram of total lysate protein. The resulting concentrations are setforth in FIG. 21 wherein the bar graph represents SEZ6 proteinconcentrations derived from LU124p3 and the LU124OXAHIp3 cell line.Expression of SEZ6 in LU124 cell lysate was 5.8 ng per mg total proteinwhile expression of SEZ6 in the LU124 oxaliplatin resistant line was14.6 ng per mg total protein. FIG. 21 shows that theoxaliplatin-resistant LU124OXAHIp3 cell line exhibited high SEZ6 proteinexpression compared to parental LU124p3 cells. These data, combined withthe mRNA transcription data for SEZ6 expression set forth in theexamples above strongly reinforces the proposition that SEZ6 proteinexpression is upregulated in tumors exhibiting chemoresistance.

Those skilled in the art will further appreciate that the presentinvention may be embodied in other specific forms without departing fromthe spirit or central attributes thereof In that the foregoingdescription of the present invention discloses only exemplaryembodiments thereof, it is to be understood that other variations arecontemplated as being within the scope of the present invention.Accordingly, the present invention is not limited to the particularembodiments that have been described in detail herein. Rather, referenceshould be made to the appended claims as indicative of the scope andcontent of the invention.

1.-19. (canceled)
 20. A method of treating (i) chemoresistant small celllung cancer or (ii) medullary thyroid cancer, comprising administeringto a subject in need thereof an antibody drug conjugate comprising amonoclonal antibody conjugated, linked, or otherwise associated with acytotoxic agent, wherein the monoclonal antibody binds to a human SEZ6protein.
 21. The method of claim 20, wherein the monoclonal antibody isselected from the group consisting of a chimeric antibody, humanizedantibody, and CDR-grafted antibody.
 22. The method of claim 20, whereinthe monoclonal antibody comprises three complementarity determiningregions of a light chain variable region comprising an amino acidsequence set forth as SEQ ID NO: 190, and three complementaritydetermining regions of a heavy chain variable region comprising an aminoacid sequence set forth as SEQ ID NO:
 191. 23. The method of claim 22,wherein the monoclonal antibody comprises residues 23-34 of SEQ ID NO:190 for CDR-L1, residues 50-56 of SEQ ID NO: 190 for CDR-L2, residues89-97 of SEQ ID NO: 190 for CDR-L3, residues 26-32 of SEQ ID NO: 191 forCDR-H1, residues 50-58 of SEQ ID NO: 191 for CDR-H2 and residues 95-102of SEQ ID NO: 191 for CDR-H3, wherein the residues are numberedaccording to Chothia.
 24. The method of claim 22, wherein the monoclonalantibody comprises residues 30-36 of SEQ ID NO: 190 for CDR-L1, residues46-55 of SEQ ID NO: 190 for CDR-L2, residues 89-96 of SEQ ID NO: 190 forCDR-L3, residues 30-35 of SEQ ID NO: 191 for CDR-H1, residues 47-58 ofSEQ ID NO: 191 for CDR-H2 and residues 93-101 of SEQ ID NO: 191 forCDR-H3, wherein the residues are numbered according to MacCallum. 25.The method of claim 22, wherein the monoclonal antibody comprisesresidues 24-34 of SEQ ID NO: 190 for CDR-L1, residues 50-56 of SEQ IDNO: 190 for CDR-L2, residues 89-97 of SEQ ID NO: 190 for CDR-L3,residues 31-35 of SEQ ID NO: 191 for CDR-H1, residues 50-65 of SEQ IDNO: 191 for CDR-H2 and residues 95-102 of SEQ ID NO: 191 for CDR-H3,wherein the residues are numbered according to Kabat.
 26. The method ofclaim 20, wherein the monoclonal antibody is an internalizing antibody.27. The method of claim 20, wherein the cytotoxic agent is apyrrolobenzodiazepine, a duocarmycin, an amanitin, an auristatin, amaytansinoid, a calicheamicin, or a radioisotope.
 28. The method ofclaim 22, wherein the cytotoxic agent is a calicheamicin.
 29. The methodof claim 20, wherein the antibody drug conjugate comprises the formulaM-[L-D]n wherein: a) M comprises the monoclonal antibody; b) L comprisesan optional linker; c) D comprises a drug, which is the cytotoxic agent;and d) n is an integer from 1 to
 20. 30. The method of claim 29, whereinthe monoclonal antibody is conjugated to the cytotoxic agent via alinker.
 31. The method of claim 30, wherein the linker comprises anon-cleavable linker.
 32. The method of claim 20 for treatingchemoresistant small cell lung cancer.
 33. The method of claim 32,wherein the small cell lung cancer is resistant to a platinum basedagent.
 34. The method of claim 33, wherein the platinum based agent iscisplatin.
 35. The method of claim 20 for treating medullary thyroidcancer.
 36. A method of treating chemoresistant small cell lung cancercomprising administering to a subject in need thereof an antibody drugconjugate comprising a humanized antibody conjugated to a cytotoxicagent, wherein the humanized antibody comprises three complementaritydetermining regions of a light chain variable region comprising an aminoacid sequence set forth as SEQ ID NO: 190, and three complementaritydetermining regions of a heavy chain variable region comprising an aminoacid sequence set forth as SEQ ID NO: 191, and wherein the cytotoxicagent comprises a calicheamicin.
 37. The method of claim 36, wherein themonoclonal antibody comprises: (a) residues 23-34 of SEQ ID NO: 190 forCDR-L1, residues 50-56 of SEQ ID NO: 190 for CDR-L2, residues 89-97 ofSEQ ID NO: 190 for CDR-L3, residues 26-32 of SEQ ID NO: 191 for CDR-H1,residues 50-58 of SEQ ID NO: 191 for CDR-H2 and residues 95-102 of SEQID NO: 191 for CDR-H3, wherein the residues are numbered according toChothia; (b) residues 30-36 of SEQ ID NO: 190 for CDR-L1, residues 46-55of SEQ ID NO: 190 for CDR-L2, residues 89-96 of SEQ ID NO: 190 forCDR-L3, residues 30-35 of SEQ ID NO: 191for CDR-H1, residues 47-58 ofSEQ ID NO: 191 for CDR-H2 and residues 93-101 of SEQ ID NO: 191 forCDR-H3, wherein the residues are numbered according to MacCallum; or (c)residues 24-34 of SEQ ID NO: 190 for CDR-L1, residues 50-56 of SEQ IDNO: 190 for CDR-L2, residues 89-97 of SEQ ID NO: 190 for CDR-L3,residues 31-35 of SEQ ID NO: 191 for CDR-H1, residues 50-65 of SEQ IDNO: 191 for CDR-H2 and residues 95-102 of SEQ ID NO: 191 for CDR-H3,wherein the residues are numbered according to Kabat.
 38. The method ofclaim 37, wherein the small cell lung cancer is resistant to a platinumbased agent.
 39. The method of claim 38, wherein the platinum basedagent is cisplatin.
 40. A method of treating medullary thyroid cancercomprising administering to a subject in need thereof an antibody drugconjugate comprising a humanized antibody conjugated to a cytotoxicagent, wherein the humanized antibody comprises three complementaritydetermining regions of a light chain variable region comprising an aminoacid sequence set forth as SEQ ID NO: 190, and three complementaritydetermining regions of a heavy chain variable region comprising an aminoacid sequence set forth as SEQ ID NO: 191, and wherein the cytotoxicagent comprises a calicheamicin.
 41. The method of claim 40, wherein themonoclonal antibody comprises: (a) residues 23-34 of SEQ ID NO: 190 forCDR-L1, residues 50-56 of SEQ ID NO: 190 for CDR-L2, residues 89-97 ofSEQ ID NO: 190 for CDR-L3, residues 26-32 of SEQ ID NO: 191 for CDR-H1,residues 50-58 of SEQ ID NO: 191 for CDR-H2 and residues 95-102 of SEQID NO: 191 for CDR-H3, wherein the residues are numbered according toChothia; (b) residues 30-36 of SEQ ID NO: 190 for CDR-L1, residues 46-55of SEQ ID NO: 190 for CDR-L2, residues 89-96 of SEQ ID NO: 190 forCDR-L3, residues 30-35 of SEQ ID NO: 191 for CDR-H1, residues 47-58 ofSEQ ID NO: 191 for CDR-H2 and residues 93-101 of SEQ ID NO: 191 forCDR-H3, wherein the residues are numbered according to MacCallum; or (c)residues 24-34 of SEQ ID NO: 190 for CDR-L1, residues 50-56 of SEQ IDNO: 190 for CDR-L2, residues 89-97 of SEQ ID NO: 190 for CDR-L3,residues 31-35 of SEQ ID NO: 191 for CDR-H1, residues 50-65 of SEQ IDNO: 191 for CDR-H2 and residues 95-102 of SEQ ID NO: 191 for CDR-H3,wherein the residues are numbered according to Kabat.